Ischemic Stroke in Adults With Congenital Heart Disease: A Population‐Based Cohort Study

Abstract

BackgroundCongenital heart disease (CHD) is associated with risk factors for ischemic stroke including cardiac arrhythmias and heart failure. However, few long‐term follow‐up data exist on ischemic stroke risk and associated mortality in adults with CHD.Methods and ResultsUsing Danish nationwide registries, we identified individuals aged ≥18 years diagnosed with CHD, at any age, from 1963 to 2017 and a sex and birth year‐matched (1:10) general population comparison cohort. We computed risks, as well as sex and birth year‐adjusted hazard ratios (aHRs) for ischemic stroke and 30‐day post‐stroke mortality in CHD adults compared with the general population. Analyses were stratified according to age <60 years (young) and ≥60 years (older). We identified 16 836 adults with CHD. The risk of ischemic stroke at age 60 years was 7.4% in the CHD cohort and 2.9% in the general population cohort. The adjusted hazard ratios for ischemic stroke compared with the general population was 3.8 (95% CI: 3.3–4.3) in young CHD adults and 1.6 (95% CI: 1.4–1.9) in older CHD adults. The adjusted hazard ratios for post‐stroke mortality compared with the general population was 2.3 (95% CI: 1.2–4.4) in young CHD adults and 1.3 (95% CI: 0.9–1.9) in older CHD adults.ConclusionsBoth younger and older CHD adults have an increased risk of ischemic stroke and by 60 years of age 7.4% of CHD adults will have had an ischemic stroke. Post‐stroke mortality was also increased in CHD adults compared with the general population.

<p>The Validity of Intracerebral Hemorrhage Diagnoses in the Danish Patient Registry and the Danish Stroke Registry</p>

“…DNPR inpatient data with primary diagnostic position codes are frequently used in Danish studies of cerebrovascular disorders, as this approach is believed to result in outcomes with higher validity than data with broader criteria (eg, inclusion of inpatients regardless of diagnostic position of code). 4,6,[46][47][48][49][50] Our findings support this strategy with regard to s-ICH. We also note that the high sensitivity of s-ICH based on inpatient primary diagnostic position codes was stable in the 9-year study period and across agegroups.…”

Lifetime risk of comorbidity in patients with simple congenital heart disease: a Danish nationwide study

“…The two cohort-based studies found an association between patients with stroke and CHD regardless of CHD severity compared with matched controls, most notably in men. 39 , 40 However, the risk differed according to the type of CHD. In fact, previous studies suggested that the CHD type was a better predictor of stroke than atherosclerotic risk factors in patients with CHD.…”

A novel TBX5 mutation predisposes to familial cardiac septal defects and atrial fibrillation as well as bicuspid aortic valve

“…As the most prevalent type of human birth defect, congenital heart defect (CHD) occurs in about 1% of all live neonates, accounting for nearly a third of all forms of developmental abnormalities (Benjamin et al, 2019;Oliveira-Brancati et al, 2020). Although minor CHD may resolve spontaneously (Benjamin et al, 2019), serious CHD may lead to poor health-related quality of life (Amedro et al, 2018(Amedro et al, , 2019Boukovala et al, 2019), reduced exercise capacity (Müller et al, 2018;Abassi et al, 2019;Smith et al, 2019), abnormal nervous develop ment or brain injury (Peyvandi et al, 2018(Peyvandi et al, , 2019Khanna et al, 2019), hemorrhagic or ischemic stroke (Bokma et al, 2018;Giang et al, 2018;Pedersen et al, 2019), pulmonary hypertension (Brida and Gatzoulis, 2018;Dimopoulos et al, 2018;Kaemmerer et al, 2018;Pascall and Tulloh, 2018), acute kidney injury or renal dysfunction (Lui et al, 2017;Gist et al, 2018), infective endocarditis (Jortveit et al, 2018;Tutarel et al, 2018;Cahill et al, 2019), cardiac dysfunction or congestive heart failure (Gilbert et al, 2018;Lal et al, 2018;Sabanayagam et al, 2018;Chan et al, 2019), ventricular or supraventricular dysrhythmia (Labombarda et al, 2017;Barry et al, 2018;Hernández-Madrid et al, 2018;Fuchs et al, 2019), and death (Lynge et al, 2018;Yu C et al, 2018). Although vast advance in cardiac surgery allows over 90% of CHD newborns to survive into adulthood, it results i...…”