Long‐Term Survival of Individuals Born With Congenital Heart Disease: A Systematic Review and Meta‐Analysis

Abstract

BackgroundEstimates of long‐term survival are required to adequately assess the variety of health and social services required by those with congenital heart disease (CHD) throughout their lives.Methods and ResultsMedline, Embase, and Scopus were searched from inception to June 2015 using MeSH headings and keywords. Population‐based studies that ascertained all persons born with CHD within a predefined area and reported survival estimates at ≥5 years were included. Unadjusted survival estimates for each CHD subtype at ages 1 year, 5 years, 10 years, and so forth were extracted. Pooled survival estimates for each age were calculated using meta‐analyses. Metaregression was performed to examine the impact of study period on survival. Of 7840 identified articles, 16 met the inclusion criteria. Among those with CHD, pooled 1‐year survival was 87.0% (95% CI 82.1–91.2), pooled 5‐year survival was 85.4% (95% CI 79.4–90.5), and pooled 10‐year survival was 81.4% (95% CI 73.8–87.9). There was significant heterogeneity of survival estimates among articles (P<0.001 for 1‐, 5‐, and 10‐year survival). A more recent study period was significantly associated with greater survival at ages 1 year (P=0.047), 5 years (P=0.013), and 10 years (P=0.046). Survival varied by CHD subtype, with 5‐year survival being greatest for those with ventricular septal defect (96.3%, 95% CI 93.7–98.2) and lowest for those with hypoplastic left heart (12.5%, 95% CI 0.0–41.4).ConclusionsAmong persons with CHD, the mortality rate is greatest during the first year of life; however, this systematic review and meta‐analysis showed that survival decreases gradually after infancy and into adulthood.

“There's no acknowledgement of what this does to people”: A qualitative exploration of mental health among parents of children with critical congenital heart defects

“…Approximately 40,000 children are born every year with a congenital heart defect (CHD) in the United States (U.S.), making CHD the leading cause of birth defect‐associated infant illness and death (Centers for Disease Control and Prevention [CDC], ). Of these children, 25% require one or more cardiac surgeries in the first year of life (CDC, ), and while the life expectancy of these children has improved considerably over the last decade (Best & Rankin, ; Oster et al., ), the field is only beginning to understand the lifelong psychological impact of these early medical interventions.…”

Survival, by Birth Weight and Gestational Age, in Individuals With Congenital Heart Disease: A Population‐Based Study

“…Survival estimates are therefore important to understand prognosis and evaluate health and social care needs. Our recent systematic review of 16 population‐based studies estimated a 5‐year survival of 85%, ranging from 14% for hypoplastic left heart to 96% for ventricular septal defect . CHD survival is strongly influenced by gestational age at birth, birth weight, and the presence of extracardiac anomalies (ie, additional congenital anomalies outside the cardiovascular system), but there is conflicting evidence for plurality, maternal age, ethnicity, and socioeconomic deprivation .…”

Socio‐economic inequalities in mortality in children with congenital heart disease: A systematic review and meta‐analysis

“…8,9 In western populations, infant mortality is around 13%, but as high as 83% for subtypes such as hypoplastic left heart (HLH). 10 Access and uptake of care are potentially important predictors of CHD survival and may be influenced by SES. 11,12 However, the overall association between SES and CHD-related mortality is rarely the focus of existing research, often being analysed as a secondary exposure or included only as potential confounding factor.…”

“…Congenital heart disease (CHD) is the most common group of congenital anomalies, affecting almost 1% of births . In western populations, infant mortality is around 13%, but as high as 83% for subtypes such as hypoplastic left heart (HLH) . Access and uptake of care are potentially important predictors of CHD survival and may be influenced by SES .…”