title: Modelling survival and mortality risk to 15 years of age for a national cohort of children with serious congenital heart defects diagnosed in infancy.
abstract: BACKGROUND
  Congenital heart defects (CHDs) are a significant cause of death in infancy. Although contemporary management ensures that 80% of affected children reach adulthood, post-infant mortality and factors associated with death during childhood are not well-characterised. Using data from a UK-wide multicentre birth cohort of children with serious CHDs, we observed survival and investigated independent predictors of mortality up to age 15 years.
  
  
  METHODS
  Data were extracted retrospectively from hospital records and death certificates of 3,897 children (57% boys) in a prospectively identified cohort, born 1992-1995 with CHDs requiring intervention or resulting in death before age one year. A discrete-time survival model accounted for time-varying predictors; hazards ratios were estimated for mortality. Incomplete data were addressed through multilevel multiple imputation.
  
  
  RESULTS
  By age 15 years, 932 children had died; 144 died without any procedure. Survival to one year was 79.8% (95% confidence intervals [CI] 78.5, 81.1%) and to 15 years was 71.7% (63.9, 73.4%), with variation by cardiac diagnosis. Importantly, 20% of cohort deaths occurred after age one year. Models using imputed data (including all children from birth) demonstrated higher mortality risk as independently associated with cardiac diagnosis, female sex, preterm birth, having additional cardiac defects or non-cardiac malformations. In models excluding children who had no procedure, additional predictors of higher mortality were younger age at first procedure, lower weight or height, longer cardiopulmonary bypass or circulatory arrest duration, and peri-procedural complications; non-cardiac malformations were no longer significant.
  
  
  CONCLUSIONS
  We confirm the high mortality risk associated with CHDs in the first year of life and demonstrate an important persisting risk of death throughout childhood. Late mortality may be underestimated by procedure-based audit focusing on shorter-term surgical outcomes. National monitoring systems should emphasise the importance of routinely capturing longer-term survival and exploring the mechanisms of mortality risk in children with serious CHDs.
authors.affiliation: Population Policy and Practice Programme, Institute of Child Health, University College London, London, United Kingdom.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Knowles
authors.affiliation: Cardiac Unit, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Bull
authors.affiliation: Department of Paediatric Cardiology, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wren
authors.affiliation: Population Policy and Practice Programme, Institute of Child Health, University College London, London, United Kingdom.
authors.forename: Angela
authors.initials: A
authors.lastname: Wade
authors.affiliation: Population Policy and Practice Programme, Institute of Child Health, University College London, London, United Kingdom.
authors.forename: Harvey
authors.initials: H
authors.lastname: Goldstein
authors.affiliation: Population Policy and Practice Programme, Institute of Child Health, University College London, London, United Kingdom.
authors.forename: Carol
authors.initials: C
authors.lastname: Dezateux
mesh_terms: D000293:Adolescent; D002423:Cause of Death; D002648:Child; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality*; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D008297:Male; D015233:Models, Statistical; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D006113:United Kingdom / Q000453:epidemiology