Treatment of Congenital Heart Disease in Denmark

Study Questions:

What are the trends in treatment and outcomes of congenital heart disease (CHD) using nationwide medical registries in Denmark?

Methods:

A case-controlled study was performed using national medical registries in Denmark. Children (<18 years) treated for CHD between 1977 and 2015 were identified. The type of intervention, need for re-intervention, and long-term survival were documented. Patients were matched to controls (10 controls per patient) in the general population by sex and year of birth. Patients were studied in three groups according to time period with period 1 from 1977 to 1989, period 2 from 1990 to 2002, and period 3 from 2013 to 2015.

Results:

A total of 9,276 patients underwent 11,854 cardiac surgeries and 1,861 catheterizations over the course of the study period. Median age at first procedure decreased from 3.4 years in period 1 to 0.8 years in period 2, and 0.6 years in period 3. Catheter-based interventions were not recorded during period 1, but were used as the initial procedure in 5.8% of patients in period 2 and 25.9% of patients in period 3. Thirty-day survival increased from 97% in period 1 to 98% in period 2 and 100% in period 3. Ten-year survival increased from 80% in period 1 to 87% in period 2 to 93% in period 3. CHD was associated with lower survival as compared with the general population during all three time periods.

Conclusions:

The authors concluded that interventional therapies have evolved since 1977, with younger age at initial intervention and greater use of catheter-based interventions. Survival remains significantly reduced as compared with the general population.

Perspective:

This study examined trends in intervention, and long-term outcomes in patients with CHD in Denmark. It is interesting to note the extremely high 30-day survival for patients with CHD after intervention, reported at 100%. Thirty-day mortality was reported in several types of congenital lesions including pulmonary atresia and univentricular heart. However, as the overall data were weighted towards patients with more common lesions associated with 100% survival, these patients did not show through in the final analysis. There is a lower than expected amount of highly complex congenital heart lesions, particularly single ventricle CHD. This is most likely due to the relatively high termination rate in Denmark for pregnancies complicated by a prenatal diagnosis of single ventricle CHD.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Cardiac Surgery and CHD & Pediatrics, Cardiac Surgery and VHD, Congenital Heart Disease, CHD & Pediatrics and Interventions, CHD & Pediatrics and Quality Improvement, Interventions and Structural Heart Disease

Keywords: Cardiac Surgical Procedures, Catheterization, Denmark, Heart Defects, Congenital, Pediatrics, Prenatal Diagnosis, Pulmonary Atresia, Survival, Treatment Outcome


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