Prevalence of congenital heart disease.
BACKGROUND
Today most patients with congenital heart disease survive childhood to be cared for by adult cardiologists. The number of physicians that should be trained to manage these lesions is unknown because we do not know the number of patients.


METHODS
To answer this question, the expected numbers of infants with each major type of congenital heart defect born in each 5-year period since 1940 were estimated from birth rates and incidence. The numbers expected to survive with or without treatment were estimated from data on natural history and the results of treatment. Finally, lesions were categorized as simple, moderate, or complex, based on the amount of expertise in management needed for optimal patient care.


RESULTS
From 1940 to 2002, about 1 million patients with simple lesions, and half that number each with moderate and complex lesions, were born in the United States. If all were treated, there would be 750,000 survivors with simple lesions, 400,000 with moderate lesions, and 180,000 with complex lesions; in addition, there would be 3,000,000 subjects alive with bicuspid aortic valves. Without treatment, the survival in each group would be 400,000, 220,000, and 30,000, respectively. The actual numbers surviving will be between these 2 sets of estimates.


CONCLUSIONS
Survival of patients with congenital heart disease, treated or untreated, is expected to produce large numbers of adults with congenital disease, and it is likely that many more adult cardiologists will need to be trained to manage moderate and complex congenital lesions.
Department of Pediatrics, University of California, San Francisco, Calif 94143, USA. jhoffman@pedcard.ucsf.edu
Julien I E
JI
Hoffman
Samuel
S
Kaplan
Richard R
RR
Liberthson
D000328:Adult; D015331:Cohort Studies; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D006801:Humans; D015995:Prevalence; D011379:Prognosis; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology