Global prevalence of congenital heart disease in school-age children: a meta-analysis and systematic review

Abstract

Background Congenital heart disease (CHD) is the commonest birth defect. Studies estimating the prevalence of CHD in school-age children could therefore contribute to quantifying unmet health needs for diagnosis and treatment, particularly in lower-income countries. Data at school age are considerably sparser, and individual studies have generally been of small size. We conducted a literature-based meta-analysis to investigate global trends over a 40-year period. Methods and results Studies reporting on CHD prevalence in school-age children (4–18 years old) from 1970 to 2017 were identified from PubMed, EMBASE, Web of Science and Google Scholar. According to the inclusion criteria, 42 studies including 2,638,475 children, reporting the prevalence of unrepaired CHDs (both pre-school diagnoses and first-time school-age diagnoses), and nine studies including 395,571 children, specifically reporting the prevalence of CHD first diagnosed at school ages, were included. Data were combined using random-effects models. The prevalence of unrepaired CHD in school children during the entire period of study was 3.809 (95% confidence intervals 3.075–4.621)/1000. A lower proportion of male than female school children had unrepaired CHD (OR = 0.84 [95% CI 0.74–0.95]; p = 0.001). Between 1970–1974 and 1995–1999, there was no significant change in the prevalence of unrepaired CHD at school age; subsequently there was an approximately 2.5-fold increase from 1.985 (95% CI 1.074–3.173)/1000 in 1995–1999 to 4.832 (95% CI 3.425–6.480)/1000 in 2010–2014, (p = 0.009). Among all CHD conditions, atrial septal defects and ventricular septal defects chiefly accounted for this increasing trend. The summarised prevalence (1970–2017) of CHD diagnoses first made in childhood was 1.384 (0.955, 1.891)/1000; during this time there was a fall from 2.050 [1.362, 2.877]/1000 pre-1995 to 0.848 [0.626, 1.104]/1000 in 1995–2014 (p = 0.04). Conclusions Globally, these data show an increased prevalence of CHD (mainly mild CHD conditions) recognised at birth/infancy or early childhood, but remaining unrepaired at school-age. In parallel there has been a decrease of first-time CHD diagnoses in school-age children. These together imply a favourable shift of CHD recognition time to earlier in the life course. Despite this, substantial inequalities between higher and lower income countries remain. Increased healthcare resources for people born with CHD, particularly in poorer countries, are required.

Status of adult outpatients with congenital heart disease in Japan: The Japanese Network of Cardiovascular Departments for Adult Congenital Heart Disease Registry

“…The proportion of ACHD patients with Fontan circulation was 6.0 %, about 1600 of those among all 54 JNCVD-ACHD institutions and approximately 10,000 in Japan. Most patients (86.4 %) with Fontan circulation were in UVH/SV, resulting in the fourth highest composite rate (6.6 %, Table 1) of UVH/SV in this study, despite a low birth rate of UVH/SV (1 %-2 %) [5][6][7][8]15] (Online Table 2). These patients may develop Fontan-associated liver disease in adulthood and are at high risks for heart failure, valvular disorders, serious arrhythmias, venous thrombosis, congestive organ failure, and protein-losing enteropathy [16].…”

“…the large number of ACHD outpatients requiring treatment for simple CHDs, such as ASD and VSD, who visited the ACHD-specialized institutions (Table 2). This rate may simply reflect the high birth rates of VSD (30 %-40 %) [5,6] and ASD (4 %-35 % of large variance caused by a large ascertain bias due to low disease detectability) [5][6][7][8] (35.2 % and 19.3 %, respectively, in Japan, Online Table 2). For those with repaired ASD, we speculate that they may have had, in addition to PAH (Table 1), other conditions such as RV dysfunction, symptomatic arrhythmias, or stroke in adulthood [9].…”

Faltering growth is an important finding in infants and children with congenital heart disease

“…The worldwide prevalence of CHD has doubled since 1995, being attributed to increased diagnosis in Asian and African continents 7. Evidence suggests most neonates with CHD are born with anthropometric measurements falling within the normal range but quickly experience nutritional challenges placing them at high risk for growth failure,2 consequently the increased burden of malnutrition in lower-income countries is not unexpected when considering the infrastructure and resources required for management of CHD.…”

Current Radiological Trends in Pediatric Congenital Heart Disease

“…По данным отечественных и зарубежных авторов наиболее распространенными ВПС являются дефект межжелудочковой перегородки (ДМЖП), дефект межпредсердной перегородки (ДМПП) и открытый артериальный проток (ОАП) (легкие пороки), на их долю приходится до 58% от общего числа ВПС [2]. Эти же ВПС являются самой частой группой нелеченых пороков у детей дошкольного и школьного возрастов: ДМЖП 30,3% от общей распространенности некоррегированных пороков, ДМПП -24,5% от общей распространенности, ОАП -13,9% [9]. Наиболее распространенными тяжелыми ВПС (на 10 тыс.…”