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

TY - JOUR

T1 - Ischemic Stroke in Adults With Congenital Heart Disease

T2 - A Population-Based Cohort Study

AU - Pedersen, Mette Glavind Bülow

AU - Olsen, Morten S

AU - Schmidt, Morten

AU - Johnsen, Søren P

AU - Learn, Christopher

AU - Laursen, Henning B

AU - Madsen, Nicolas L

PY - 2019/8/6

Y1 - 2019/8/6

N2 - Background Congenital 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 Results Using 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. Conclusions Both 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.

AB - Background Congenital 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 Results Using 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. Conclusions Both 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.

KW - ARRHYTHMIAS

KW - ATRIAL-FIBRILLATION

KW - DIAGNOSES

KW - EVENTS

KW - PREVALENCE

KW - REGISTER

KW - RISK STRATIFICATION SCHEMES

KW - VALIDITY

KW - congenital heart disease

KW - population-based

KW - prognosis

KW - stroke

UR - http://www.scopus.com/inward/record.url?scp=85075022551&partnerID=8YFLogxK

U2 - 10.1161/JAHA.118.011870

DO - 10.1161/JAHA.118.011870

M3 - Journal article

C2 - 31315496

SN - 2047-9980

VL - 8

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

IS - 15

M1 - 011870

ER -