Long-Term Mortality in Atrial Septal Defect Patients

Dec 14, 2017
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Authors:
Nyboe C, Karunanithi Z, Nielsen-Kudsk JE, Hjortdal VE.
Citation:
Long-Term Mortality in Patients With Atrial Septal Defect: A Nationwide Cohort Study. Eur Heart J 2017;Dec 2:[Epub ahead of print].
Summary By:
Timothy B. Cotts, MD, FACC

Study Questions:

What is the long-term survival in adults with atrial septal defect (ASD) as compared with the general population?

Methods:

The study used nationwide population-based registries in Denmark. The study included Danish individuals with a diagnosis of ASD born prior to 1994 who were diagnosed between 1959 and 2013. The mortality of ASD patients was compared with that of a birth year and sex-matched general population cohort (10 controls per patient). Cox proportional hazards regression and a modified Charlson Comorbidity Index were used to account for risk factors and comorbidities.

Results:

A total of 2,277 patients met inclusion criteria for the study. The median follow-up from the time of ASD diagnosis was 18.1 years, with a range from 1-53 years. Patients with ASD had a higher mortality (adjusted hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.5-1.9) compared with the general population. The adjusted HR 30 days after closure was 1.4 (95% CI, 1.2-1.7) as compared with 2.4 (95% CI, 2.0-2.9) for patients without closure.

Conclusions:

The authors concluded that ASD patients had a higher long-term mortality than the general population. There was a lower relative mortality for ASD patients undergoing closure as compared with those patients not undergoing closure.

Perspective:

Existing data are mixed as to the impact of a diagnosis of ASD on long-term mortality. This population-based study in Denmark demonstrated a higher long-term mortality for those with ASD as compared with a birth year and sex-matched control population. Additionally, patients who underwent ASD closure had improved survival as compared with those who did not. This study supports the need for continued follow-up and monitoring for indications for ASD closure, even in those patients with relatively small defects.

Keywords: Comorbidity, Heart Defects, Congenital, Heart Septal Defects, Atrial, Mortality, Risk Factors, Secondary Prevention, Survival


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