Epidemiology Of Congenital Heart Disease Research Articles

Incidence and types of congenital heart disease at a referral hospital in Jordan: retrospective study from a tertiary center.

Congenital heart disease (CHD) is the most common birth defect and accounts for significant global morbidity and mortality. Relatively little is known about the epidemiology of CHD in Jordan or the manner in which CHD is identified. A retrospective medical record review was conducted for all neonates who had an abnormal echocardiogram performed at a tertiary referral hospital. All included neonates had echocardiography performed by the same pediatric cardiologist at the discretion of the treatment team. Descriptive statistics were used to describe CHD incidence, types of CHD identified, and mechanism of identification. The incidence of congenital heart disease was 17.8 per 1,000 live births. This rose to 24.6 per 1,000 if patent ductus arteriosus in preterm infants was included. The most common identified abnormalities were PDA, atrial septal defects, persistent pulmonary hypertension, septal hypertrophy, and ventricular septal defects. Most children were evaluated either for a murmur heard on exam or as a part of screening due to other comorbidities or risk factors. Less than 1% of children had a prenatal diagnosis. There was a higher rate of persistent pulmonary hypertension during the COVID-19 pandemic than before (p < 0.001). There is a high incidence of CHD in Jordan. Increased prenatal and perinatal screening for CHD may allow for earlier detection.

Associated Factors with Congenital Heart Disease in the Most Populated State of Brazil Between 2010 and 2018

Background Cardiac anomalies are the most prevalent congenital malformations among live births in the world. In Brazil, it is estimated that nearly 25,757 new cases occur each year, and the Southeast region presents the highest prevalence, with 10 new cases/1,000 live births. Objective The aim of this study is to evaluate the epidemiology of congenital heart disease (CHD) in the state of São Paulo. Methods This is a cross-sectional and time-series observational study with data from the Brazilian Information [...]

Changing epidemiology of congenital heart disease: effect on outcomes and quality of care in adults.

The epidemiology of congenital heart disease (CHD) has changed in the past 50 years as a result of an increase in the prevalence and survival rate of CHD. In particular, mortality in patients with CHD has changed dramatically since the latter half of the twentieth century as a result of more timely diagnosis and the development of interventions for CHD that have prolonged life. As patients with CHD age, the disease burden shifts away from the heart and towards acquired cardiovascular and systemic complications. The societal costs of CHD are high, not just in terms of health-care utilization but also with regards to quality of life. Lifespan disease trajectories for populations with a high disease burden that is measured over prolonged time periods are becoming increasingly important to define long-term outcomes that can be improved. Quality improvement initiatives, including advanced physician training for adult CHD in the past 10 years, have begun to improve disease outcomes. As we seek to transform lifespan into healthspan, research efforts need to incorporate big data to allow high-value, patient-centred and artificial intelligence-enabled delivery of care. Such efforts will facilitate improved access to health care in remote areas and inform the horizontal integration of services needed to manage CHD for the prolonged duration of survival among adult patients.

Impact of prenatal screening on congenital heart defects in neonates with Down syndrome in the US.

Non-invasive prenatal screening (NIPS) has fundamentally changed thescreening processfor Down syndrome (DS). Rates of complex congenital heart defects (CHD) have decreased in international studies but whether these shifts exist in the US is unknown. Encounters for neonates with DS from 2007 to 2018 were obtained from the Pediatric Health Information System database. CHD were categorized as complexCHD, atrioventricular septal defects (AVSD), ventricular septal defects (VSD), and tetralogy of Fallot (TOF). Comparisons were made between pre-NIPS era (2007-2010) vs. post-NIPS era (2014-2018) and between states with low vs. high access to pregnancy termination as described by the Guttmacher Institute. Among 9122 patients, 6% had complex CHD, 22% had an AVSD, 22% had a VSD, and 4% had TOF. No difference in proportions of CHD was seen between eras. A small difference was observed in the proportion of AVSD between states with low vs. high access to pregnancy termination (23 vs. 17%, p < 0.001). The proportion of CHD in patients with DS appears to be stable despite widespread adoption of NIPS in the US. Variations were observed between states with low vs. high access to pregnancy termination. Population based studies are needed to fully evaluate the current epidemiology of CHD in DS. Through investigation of the Pediatric Health Information System database, this study assesses contemporary epidemiology of congenital heart disease among patients with Down syndrome. It has been suggested that improved prenatal screening for Down syndrome has altered the cardiac phenotype in international populations. Whether a similar shift also exists in the United States is unknown. In a contemporary United States cohort, a shift in the proportion or type of heart defects over the past decade was not observed. Regional differences in the proportion of heart defects were seen and may be due to differential access to prenatal care.

Epidemiological study of congenital heart diseases in dogs: Prevalence, popularity, and volatility throughout twenty years of clinical practice.

The epidemiology of Congenital Heart Diseases (CHDs) has changed over the past twenty years. This study aimed to evaluate the prevalence of CHDs in the population of dogs recruited in a single referral center (RC); compare the epidemiological features of CHDs in screened breeds (Boxers) versus non-screened (French and English Bulldogs, German Shepherds); investigate the association of breeds with the prevalence of CHDs; determine the popularity and volatility of breeds over a 20-year period; analysed the trends of the most popular breeds in the overall population of new-born dogs registered in the Italian Kennel Club (IKC) from 1st January 1997 to 31st December 2017. The RC’s cardiological database was analysed, and 1,779 clinical records were included in a retrospective observation study. Descriptive statistics and frequencies regarding the most representative breeds and CHDs were generated. A logistic regression model was used to analyse the trends of the most common CHDs found in single and in cluster of breeds. The relationship between breed popularity and presence of CHDs was studied. The most common CHDs were Pulmonic Stenosis, Patent Ductus Arteriosus, Subaortic Stenosis, Ventricular Septal Defect, Aortic Stenosis, Tricuspid Dysplasia, Atrial Septal Defect, Double Chamber Right Ventricle, Mitral Dysplasia, and others less frequent. The most represented pure breeds were Boxer, German Shepherd, French Bulldog, English Bulldog, Maltese, Newfoundland, Rottweiler, Golden Retriever, Chihuahua, and others in lower percentage. Chihuahuas, American Staffordshire Terriers, Border Collies, French Bulldogs, and Cavalier King Charles Spaniel were the most appreciated all of which showed a high value of volatility. This study found evidence for the value of the screening program implemented in Boxers; fashions and trends influence dog owners’ choices more than the worries of health problems in a breed. Effective breeding programs are needed in order to control the diffusion of CHDs without impoverishing the genetic pool.

The state of congenital heart disease.

In this special issue of the American Journal of Medical Genetics Part C, we focus on the "State of Congenital Heart Disease." We anticipate that after viewing this journal, the reader will be up-to-date on the epidemiology of congenital heart disease (CHD), the genetic basis of CHD, ethical concerns, and the global impact of CHD. And most importantly, we are confident that this special issue conveys the message that CHD is complex and that much work is still needed in genetic and genomic research.

Epidemiology of Congenital Heart Diseases in Tikrit Teaching Hospital

Epidemiology of Congenital Heart Diseases in Tikrit Teaching Hospital

The birth prevalence, severity, and temporal trends of congenital heart disease in the middle-income country: A population-based study.

There is limited data on congenital heart disease (CHD) from the lower- and middle-income country. We aim to study the epidemiology of CHD with the specific objective to estimate the birth prevalence, severity, and its trend over time. A population-based study with data retrieved from the Pediatric Cardiology Clinical Information System, a clinical registry of acquired and congenital heart disease for children. State of Johor, Malaysia. All children (0-12years of age) born in the state of Johor between January 2006 and December 2015. None. The birth prevalence, severity, and temporal trend over time. There were 531,904 live births during the study period with 3557 new cases of CHD detected. Therefore, the birth prevalence of CHD was 6.7 per 1000 live births (LB) (95% confidence interval [CI]: 6.5-6.9). Of these, 38% were severe, 15% moderate, and 47% mild lesions. Hence, the birth prevalence of mild, moderate, and severe CHD was 3.2 (95% CI: 3.0-3.3), 0.9 (95% CI: 0.9- 1.1), and 2.6 (95% CI: 2.4-2.7) per 1000 LB, respectively. There was a significant increase in the birth prevalence of CHD, from 5.1/1000 LB in 2006 to 7.8/1000 LB in 2015 (P<.0001) due to increase in detection of both mild (1.9/1000 LB in 2006 to 3.9/1000 LB in 2015, P<.001) and severe CHD (1.8/1000 LB in 2005 to 2.9/1000 LB in 2015, P<.001). The birth prevalence of CHD was 6.7 per 1000 live births, and two in five were severe and significantly associated with syndrome and extracardiac defect. There was a significant increase in the detection of severe lesions in recent years leading to more burden to resources that are already limited in the middle-income country. Therefore, strategic and comprehensive pediatric and congenital heart surgery program is required.

Clinical epidemiology of congenital heart disease in Nigerian children, 2012-2017.

Congenital heart diseases (CHDs) affect ~1% of newborns and are a significant cause of morbidity and mortality in children. We present the clinical epidemiology of CHD as seen in a large university medical center in Nigeria. Participants were 767 children with echocardiographically confirmed CHD seen over a 5-year period at the Lagos University Teaching Hospital, Nigeria. Clinical presentation was often late with just over half (58.1%) presenting in infancy. The male:female distribution was 1:1. The predominant types of cardiac lesion seen were septal defects (43%), conotruncal defects (23.7%), atrioventricular septal defects (9.8%), and right ventricular outflow tract obstruction (7.3%). Cyanotic CHD was seen in 28.4% of cases and the single most common cyanotic CHD was Tetralogy of Fallot (13.4%). Children with cyanotic CHD were older (p = .002), had more severe lesions (p < .0001) and were more likely to have cardiac intervention (p < .0001). Extracardiac malformations were present in nearly one-third of the children. Syndromes associated with CHD were identified in 15.5% of the children and included Down syndrome (11.9%), congenital rubella syndrome (1.0%), and Marfan syndrome (0.7%). This study is a large case series of CHD from a single site in sub-Saharan Africa utilizing clinical, epidemiological, and developmental considerations. It provides a rich and up-to-date description of the clinical epidemiology of CHD in Nigerian children while yielding data that could be useful for designing genetic, molecular, and biomarker studies.

Burden of congenital heart diseases in a tertiary cardiac care institute in Western India: Need for a national registry

Objective: Congenital heart disease (CHD) is very common disease, and it is the major cause of childhood mortality and morbidity. Not much of Indian data are available particularly from the western part of the country. There are needs to further explicate the spectrum and epidemiology of the CHD. Materials and Methods: This retrospective study collected data of the paediatric patients received in our institute from January 2016 to June 2017. All simple and complex congenital anomalies diagnosed on echocardiography were included in our study. Results: Of total 22,275 cases, CHDs were diagnosed in 9728 cases with a male-to-female ratio of 1:0.6. Most CHDs (62.77%) were diagnosed between 1 month and 6 years of age. Incidence of cyanotic CHD was 27.14% and acyanotic CHDs was 72.86% with a ratio of cyanotic-to-acyanotic CHD being 1:2.7. Ventricular septal defect (26.24%) was the most common acyanotic CHD found followed by 2089 patients of atrial septal defect. Tetralogy of Fallot (13.57%) was the most common cyanotic CHD found followed by double-outlet right ventricle in 276 patients (2.84%). Conclusions: Ours is the largest Indian study till date in this spectrum which yielded new data on the epidemiology, incidence, and prevalence of CHD. Majority of the patients with CHD had acyanotic CHD with most common anomaly being ventricular septal defect. Tetralogy of Fallot was the most common cyanotic defect. This study will increase awareness in the people with a family history of CHD and health-care providers and will assist in early diagnosis.

Epidemiology of congenital heart diseases in Bogotá, Colombia, from 2001 to 2014: Improved surveillance or increased prevalence?

Congenital heart diseases are functional and structural alterations of the heart, circulatory system, and large vessels, which develop during cardiac embryogenesis. These defects are significant causes of morbidity and mortality in children worldwide. To determine the prevalence of congenital heart diseases in Bogotá, Colombia, through the period 2001 to 2014 and evaluate the trend in time. We analyzed 405,408 births from the Programa de Vigilancia y Seguimiento de Niños con Anomalías Congénitas de la Secretaría Distrital de Salud de Bogotá. We calculated the prevalence of congenital heart diseases through a daily registry of births, the clinical evaluation, and the work-up. Congenital heart diseases were classified as isolated, complex or associated. We estimated the prevalence per year and the mortality in the first hours of life. The total prevalence of congenital heart diseases was 15.1 per 10,000 newborns; however, we obtained values above 20 per 10,000 newborns in the previous 3 years. Of the newborns analyzed, 46% were females, 53.16% were males, and 0.33% undetermined. Out of the newborns with congenital anomalies, 397 had congenital heart diseases, 142 of which were classified as associated and 74 as complex. Congenital heart diseases have a significant impact on childhood morbidity and mortality. Although the prevalence continues to be low compared to other countries, this could be due to under registry nationwide. There was an increase in prevalence during the previous three years, which might be explained by the implementation of local and national programs. Therefore, we suggest continuing the development and promotion of such programs aimed at increasing screening and registration of these anomalies.

Réadaptation cardiaque de l’enfant et l’adulte avec une cardiopathie congénitale

Advances in heart surgery over the past 30years have significantly improved the prognosis of congenital heart diseases (CHD). Therefore, the epidemiology of CHD has changed dramatically with a shift of mortality from pediatrics to adulthood and an increased prevalence of complex CHD. Today, caregivers and patients focus their interests to new perspectives: improving the quality of life, practicing sports, improving psychosocial care. Cardiac rehabilitation is completely integrated in these new therapeutic strategies. The starting point is the cardiopulmonary exercise test (CPET), with the measurement of oxygen uptake, or "VO2". CPET is now recommended in the follow-up of the adults with CHD. Maximum oxygen uptake correlates to the quality of life of children and adults with CHD. The principles of the rehabilitation in patients with heart failure may usually be applied to CHD patients. Some studies in complex CHD showed improvement of VO2and quality of life after rehabilitation, without any adverse events. However few physicians have the experience in rehabilitation among CHD patients, especially children. Randomized trials on cardiac rehabilitation in adult and pediatric CHD patients are essential to increase the level of evidence and lead to specific guidelines in this population.

Epidemiology of congenital heart disease in Brazil.

IntroductionCongenital heart disease is an abnormality in the structure or cardiocirculatory function, occurring from birth, even if diagnosed later. It can result in intrauterine death in childhood or in adulthood. Accounted for 6% of infant deaths in Brazil in 2007.ObjectiveTo estimate underreporting in the prevalence of congenital heart disease in Brazil and its subtypes.MethodsThe calculations of prevalence were performed by applying coefficients, giving them function rates for calculations of health problems. The study makes an approach between the literature and the governmental registries. It was adopted an estimate of 9: 1000 births and prevalence rates for subtypes applied to births of 2010. Estimates of births with congenital heart disease were compared with the reports to the Ministry of Health and were studied by descriptive methods with the use of rates and coefficients represented in tables.ResultsThe incidence in Brazil is 25,757 new cases/year, distributed in: North 2,758; Northeast 7,570; Southeast 10,112; South 3,329; and Midwest 1,987. In 2010, were reported to System of Live Birth Information of Ministry of Health 1,377 cases of babies with congenital heart disease, representing 5.3% of the estimated for Brazil. In the same period, the most common subtypes were: ventricular septal defect (7,498); atrial septal defect (4,693); persistent ductus arteriosus (2,490); pulmonary stenosis (1,431); tetralogy of Fallot (973); coarctation of the aorta (973); transposition of the great arteries (887); and aortic stenosis 630. The prevalence of congenital heart disease, for the year of 2009, was 675,495 children and adolescents and 552,092 adults.ConclusionIn Brazil, there is underreporting in the prevalence of congenital heart disease, signaling the need for adjustments in the methodology of registration.

The school age child with congenital heart disease.

Currently, in the United States, there are approximately 1 in 150 adults living with congenital heart disease (CHD) (). Infant and childhood mortality related to CHD decreased by 31% between 1987 and 2005 (). This survival trend is predicted to increase each year due to advancements in treatment and management of CHD. This significant shift in the epidemiology of CHD requires nurses to take action in preparing children with CHD and their families for their teenage years and young adulthood. The school-age child is the ideal age to begin teaching the child about their healthcare needs and how to care for themselves in preparation for the future. The school-age child with CHD has specific physical, intellectual, emotional, and developmental needs that must be considered and managed using a multidisciplinary approach. Pediatric nurses must be aware of these needs as they help the child and their family seamlessly and successfully transition into young adulthood as a happy and healthy CHD survivor.

OP29 The prevalence of congenital heart disease in the UK: a population-based register study

Background Congenital heart disease (CHD) is the most common group of structural congenital anomalies. Individuals with CHD require highly specialised health care, which may involve multiple complex and often life-saving surgeries. Current reforms of paediatric cardiology services in the UK are taking place to ensure adequate provisions are in place for children with CHD. Obtaining accurate information on trends and prevalence will aid health service planning in this area. Several studies have analysed trends in the prevalence of CHD, but few have investigated trends specific to CHD subtypes or severity categories. The aim of this study was to investigate the epidemiology of CHD, including trends in severe, moderate and mild CHD in the UK. Methods All cases of CHD notified to six British Isles Network of Congenital Anomaly Registers between 1991–2010 formed this population-based study. Prevalence and 95% confidence intervals (CIs) were calculated as the number of cases (in live births, fetal deaths or terminations of pregnancy for fetal anomaly) per 10,000 live and stillbirths. Relative risks (RRs) of CHD over time and by maternal age at delivery were estimated using multilevel Poisson models. Results There were 19,384 singleton cases of CHD among 3,040,952 total births. Excluding, 3777 (19.5%) cases with a chromosomal anomaly or genetic syndrome and 2370 (12.2%) with extra-cardiac anomalies, there were 13,237 isolated cases. Of these, 7032 (53.1%, Prevalence = 23.1, 95% CI: 22.6–23.7 per 10,000 total births) were mild, 3389 (25.6%, Prevalence = 11.1, 95% CI: 10.8–11.5) were moderate and 1145 (8.7%, Prevalence = 3.8, 95% CI: 3.6–4.0) were severe CHD. There were no significant trends in moderate (RR=1.02, 95% CI: 0.99–1.04; p = 0.195) or severe CHD (RR=1.01, 95% CI: 1.00–1.03; p = 0.065), but there was a significant increase in the prevalence of mild CHD (RR=1.05, 95% CI: 1.01–1.10; p = 0.029). The trends over time remained relatively unchanged after adjustment for maternal age at delivery. Compared to women aged 20–29, the risk of mild CHD was significantly increased in the offspring of women aged ≥35 (RR=1.10, 95% CI: 1.02–1.19; p = 0.016) and the risk of severe CHD was significantly greater in the offspring of women aged 30–34 (RR=0.80, 95% CI: 0.65–0.98; p = 0.030). There were no associations in any other maternal age category. Conclusion There were no significant trends in the prevalence of severe or moderate CHD but there was evidence of an increase in mild CHD prevalence, which existed after adjustment for maternal age at delivery. This information is important for healthcare planning.

Changing prevalence of severe congenital heart disease: a population-based study.

Although the epidemiology of congenital heart disease (CHD) has been described, the authors believe changes in prenatal factors such as termination of pregnancy for fetal anomaly and prenatal vitamin supplementation have altered the birth prevalence of severe CHD. This population-based study reviewed the Nationwide Inpatient Sample (NIS) database and identified all cases with a severe CHD diagnosis among all live birth entries from 1999 to 2008. A time trend analysis then was performed for specific severe CHD diagnoses stratified by race, socioeconomic status, and geographic location. Overall, severe CHD prevalence was 147.4 per 100,000 live births, with a temporal decrease in prevalence from 168.9 per 100,000 in 1999 to 129.3 per 100,000 in 2008 (p = 0.03). Among the 12 severe CHD diagnoses included in our cohort, the prevalence of truncus arteriosus (p = 0.02), tetralogy of Fallot (p = 0.001), hypoplastic left heart syndrome (p = 0.001), and pulmonary atresia (p = 0.01) decreased significantly during the study period. The observed prevalence trends varied significantly by race (Caucasians), socioeconomic class (upper income quartiles), and geographic location (Northeast and West regions). The study findings showed a temporal decrease in severe CHD prevalence, which varied by race, socioeconomic status, and geographic location. The authors speculated that the observed trend might be due to increased termination of fetuses with prenatally diagnosed CHD. The impact of sociodemographic variables on the observed prevalence trend might be due to differences in access to specialized perinatal care and fetal heart programs or because of variability in termination of pregnancy.

Call for multinational studies of the epidemiology of congenital heart disease in the Arab world

Congenital Heart Disease (CHD) is the commonest congenital anomaly worldwide representing nearly one third of all congenital malformations presenting in the neonatal period. Arabs have a high fertility rates and they are liable to have more children with congenital defects including CHD. High rates of consanguineous marriages may increase rates of congenital and genetic anomalies. No reliable statistics exist and assumption that the incidence of congenital defects in the Arab world being greater than the rest of the world is only anecdotal. It is therefore crucial and timely to have a multinational and multicenter study of the incidence of CHD in the Arab world. Creation of cross the Arab world multinational congenital cardiac defects registry program and stratification is essential prerequisite to develop good pediatric cardiac services. Over the last two decades, some Arab countries have already started their pediatric cardiac programs. The author call upon other countries to follow suit and learn from their experiences.

Spectrum of congenital heart diseases in an African population: A necropsy study

Background: The spectrum and incidence of congenital heart diseases amongst African population are not well defined in literature. There is the need to further elucidate the spectrum and epidemiology of congenital heart diseases amongst African. Aim: This study was conducted to highlight the spectrum and occurrence of congenital heart diseases in an African population. Methodology: All paediatric patients who were autopsied over a 98-month period were checked for occurrence of congenital heart diseases. Attempts were made to ascertain the primary disease and causes of death. We noted their bio-data, ages, sexes and causes of death. The results were analysed with SPSS version 17. The results formed the basis for discussion and recommendations. Results: There were 135 cardiac related deaths and 36 of them were in paediatric age brackets. The mean age was 4.7 + 1.08 months with a standard deviation of 6.27. M:F ratio was 1:1.1. The commonest anomaly was ventricular septal defect. There was a weak association with other congenital anomalies. The commonest cause of death was bronchopneumonia. Discussion and Recommendation: The disease pattern showed reasonable similarity with reports from other parts of the world. However, there is need for development of capacity for prenatal diagnosis of congenital heart diseases in Africa. This will widen the net of diagnosis and improve accuracy of incidence studies in Africa.

The Future of ACHD Care Symposium: Changing demographics of congenital heart disease

In this article, we demonstrate that congenital heart disease (CHD) has now become a life-long condition spanning from birth to old age. We begin by understanding the determinants of demographics in terms of the changing epidemiology of CHD: incidence, survival and prevalence of CHD across the lifespan.The reported birth prevalence of CHD most commonly clusters around 8/1000 live births. Advances in medical and surgical therapy have led to an increase in the survival of CHD patients with an increase in the median age at death in those with severe CHD of 20years since l987. The prevalence of CHD increased by 22% in children and 85% in adults with severe CHD from 1985 to 2000 such that in the year 2000, CHD prevalence in Quebec was 4/1000 adults and 12/1000 children. Thus, the median age of those alive with severe CHD has also increase from 11 to 17years as observed from 1985 to 2000 and is expected to further increase between 2000 and 2020. There are data suggesting a female predominance in the ACHD population which may impact birth rates of CHD in the future. The estimated number of adults with CHD who have severe or complex disease is likely to be 10–25% when population data are considered.The impact of changing demographics on clinical outcomes and disease burden on the adult CHD population has become considerable. Our commitment to patient care necessitates that we continue to improve the quality of care based on the needs of this population as illustrated by trends in medical complications and health services utilization.

Donald Charles Fyler: 1924–2011

We are honoured to provide a tribute to Dr Donald Fyler in Cardiology in the Young on the occasion of his induction into the Paediatric Cardiology Hall of Fame. Among his extraordinary contributions to paediatric cardiovascular disease, he described the epidemiology of congenital heart disease; created the framework for regionalised data collection, collaboration, and care in New England; and designed a standardised system of codes for congenital heart disease in wide use today.