Hypoplastic left heart syndrome in US military family members: trends in intervention, survival, and prevalence.
BACKGROUND
Hypoplastic left heart syndrome was uniformly fatal until the 1980s but now has survival approaching 70% to age 5 due to treatment advances. The current study was undertaken to examine trends in the intervention rate, survival, and prevalence of hypoplastic left heart syndrome among US military family members. We hypothesized that increased rates of intervention and survival would produce a demonstrable increase in prevalence in this population.


METHODS
This was a retrospective review of administrative data. Central databases contain records from Army hospital admissions since 1972, all military hospital admissions since 1989, outpatient visits since 2000, and civilian bills to the military system since 2000. Patients with an instance of the relevant diagnosis (code 746.7) were included and all of their data records reviewed. Patients with incompatible diagnoses or survival were excluded.


RESULTS
There were 366 patients identified, 63 born in the 1980s, 155 in the 1990 s, and 148 after 2000. The rate of intervention increased from 54% in the 1990 s to 97% in the 2000s (P < .001). Five-year survival increased markedly between the 1980s and the 1990 s. For patients born since 2000 and undergoing intervention, survival was 66% to 21 months (95% confidence interval 56-75%). Prevalence at birth in military hospitals was 1.4 per 10,000 with no significant trend over time. Prevalence among inpatients other than at birth increased from 0.4 to 15 per 10,000 between 1989 and 2005 (r(2) = 0.92, P < .001).


CONCLUSIONS
The rates of intervention and survival of patients with hypoplastic left heart syndrome have increased dramatically over the past 15 years. This has resulted in a demonstrable increase in prevalence among the beneficiary population. Future study focused on this cohort could detail their healthcare needs and demonstrate the effect of hypoplastic left heart syndrome on the family and its growing impact on the military healthcare system.
Scott
John S
JS
Military Casualty Research Division, Walter Reed Army Institute of Research, Silver Spring, MD 20907, USA. john.s.scott1@us.army.mil
Niebuhr
David W
DW
D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D013504:Cardiovascular Surgical Procedures / Q000706:statistics & numerical data; D002675:Child, Preschool; D005190:Family; D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D007223:Infant; D008297:Male; D008887:Military Medicine / Q000191:economics / Q000639:trends*; D008889:Military Personnel / Q000706:statistics & numerical data*; D015995:Prevalence; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States