PhD Scientific Days 2022

Clinical Medicine I. (Poster discussion will take place in the Aula during the Coffee Break)

Adults with congenital heart disease over the age of 60 – data from a single tertiary centre

Text of the abstract

Introduction We are currently facing a shift to older and more complex adult patients with congenital heart disease (ACHD). This changing and growing population of elderly patients provides new challenges to clinicians.
Our aim was to identify the main comorbidities and the predictors of death in this population.
Methods 296 patients were identified as ≥ 60 years of all the inpatient and outpatient visits at our centre between 2000 and 2022. Patients with isolated PFO, simple valvular lesions, and bicuspid aortic valve were excluded. Clinical data was collected retrospectively from digital medical records. Patients were classified as simple, and complex based on the complexity of the congenital heart disease (CHD). Survival difference was analysed using the Kaplan-Meier method and the log rank test. Mortality predictors were tested with univariate and multivariate regression.
Results Senior patients in this study were predominantly female (73%) with the median age of 69.3±7.1 years. We included 296 patients with simple (52.4%), and complex (47.6%) underlying CHD. The complex group mainly consisted of patients with Ebstein’s anomaly, ccTGA, Eisenmenger syndrome, and shunt lesions with pulmonary hypertension, while patients with simple lesions had either pulmonary stenosis or simple shunt lesions. Comorbidities with the highest prevalence were hypertension (47.6%), cancer (12.8%) and coronary artery disease (12.5%). The prevalence of hypertension was significantly higher (p=0.013) in patients with simple defects. During the median follow-up of 10±6.7 years (after the age of 60 years) 56 (18.9%) patients died with the incidence of 2.27 deaths/100 patient years. On multivariate Cox analysis, the severity of the CHD (p=0.001), age (p<0.001) and cancer (p=0.018) were the strongest prognostic factors. The main cause of death was malignancy and heart failure. Mortality was significantly higher in patients with complex defects (p<0.001).
Conclusions The number of complex patients over the age of 60 is constantly rising. The prevalence of coronary artery disease and cardiovascular risk factors was lower, than in the general population. As expected, significantly higher mortality was seen in those with complex defects. Ageing, complexity of the CHD, and malignancy were the main predictors of death.
Funding EFOP – 3.6.3-VEKOP-16-2017-00009