Changing epidemiology of congenital heart disease: effect on outcomes and quality of care in adults

The epidemiology of congenital heart disease (CHD) has changed in the past 50 years as a result of an increase in the prevalence and survival rate of CHD. In particular, mortality in patients with CHD has changed dramatically since the latter half of the twentieth century as a result of more timely diagnosis and the development of interventions for CHD that have prolonged life. As patients with CHD age, the disease burden shifts away from the heart and towards acquired cardiovascular and systemic complications. The societal costs of CHD are high, not just in terms of health-care utilization but also with regards to quality of life. Lifespan disease trajectories for populations with a high disease burden that is measured over prolonged time periods are becoming increasingly important to define long-term outcomes that can be improved. Quality improvement initiatives, including advanced physician training for adult CHD in the past 10 years, have begun to improve disease outcomes. As we seek to transform lifespan into healthspan, research efforts need to incorporate big data to allow high-value, patient-centred and artificial intelligence-enabled delivery of care. Such efforts will facilitate improved access to health care in remote areas and inform the horizontal integration of services needed to manage CHD for the prolonged duration of survival among adult patients. The mortality and birth prevalence of congenital heart disease (CHD) have shifted in the past 50 years owing to advances in diagnosis and treatment. In this Review, Marelli and colleagues discuss the effect of this shift in CHD epidemiology on outcomes and disease burden in adult patients and describe new initiatives and technology that can improve the delivery of health care.

Automated summary

The epidemiology of congenital heart disease (CHD) has changed in the past 50 years due to the increasing prevalence and survival rate of CHD. The mortality in CHD patients has dramatically changed since the latter half of the twentieth century as a result of timely diagnosis and intervention development. As CHD patients age, the burden of the disease shifts from the heart to acquired cardiovascular and systemic complications. The societal costs of CHD are high, both in terms of healthcare utilization and quality of life.