title: Congenital heart disease beyond the age of 60: emergence of a new population with high resource utilization, high morbidity, and high mortality.
abstract: OBJECTIVE
  The population of adults with congenital heart disease (ACHD) is growing and ageing. Limited information about the diagnostic spectrum of this emerging population, its resource utilization at tertiary ACHD centres, and especially about prognostic parameters is available.
  
  
  RESULTS
  Retrospective cohort study on all ACHD patients ≥60 years of age under active follow-up. All-cause mortality was the primary outcome measure. Out of a total population of 7315 ACHD patients, 375 [190 females (50.7%), mean age 64.8 ± 5.9 years] fulfilled the inclusion criteria. During a median follow-up of 5.5 (IQR 3.1-8.6) years, 55 of the 375 patients died. The number of interventions (P = 0.0006), the number and length of hospitalization (P < 0.0001), and the number of outpatient clinic visits (P < 0.0001) were significantly higher in patients ≥60 compared with patients aged between 20 and 60 years. Patients ≥60 years of age with moderate or severe congenital heart defects had worse survival prospects than their age- and gender-matched comparison population. On multivariate Cox analysis, coronary artery disease [hazard ratio (HR): 5.04; 95%CI: 1.88-13.51, P = 0.0014], symptoms of heart failure (HR: 2.36; 95%CI: 1.05-5.29, P < 0.05), NYHA class (HR: 1.96; 95%CI: 1.18-3.26, P < 0.01), and moderate to severe reduction in systemic ventricular systolic function (HR: 1.90; 95%CI: 1.20-2.99, P < 0.001) were the strongest prognostic factors.
  
  
  CONCLUSIONS
  There is a growing number of elderly ACHD patients with high mortality rates and a higher utilization of healthcare resources compared with younger patients. Acquired morbidities, such as coronary artery disease, seem to be key determinants of outcome in this older population in conjunction with the underlying congenital heart disease.
authors.affiliation: Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension, Royal Brompton Hospital and Harefield NHS Foundation Trust, Sydney Street, London SW3 6NP, UK.
authors.forename: Oktay
authors.initials: O
authors.lastname: Tutarel
authors.forename: Aleksander
authors.initials: A
authors.lastname: Kempny
authors.forename: Rafael
authors.initials: R
authors.lastname: Alonso-Gonzalez
authors.forename: Richard
authors.initials: R
authors.lastname: Jabbour
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Anselm
authors.initials: A
authors.lastname: Uebing
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Dimopoulos
authors.forename: Lorna
authors.initials: L
authors.lastname: Swan
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gatzoulis
authors.forename: Gerhard-Paul
authors.initials: GP
authors.lastname: Diller
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011379:Prognosis; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Adult congenital heart disease; Coronary artery disease; Outcome