title: The Fontan epidemic: Population projections from the Australia and New Zealand Fontan Registry.
abstract: BACKGROUND
  The number and age demographic of the future Fontan population is unknown.
  
  
  METHODS
  Population projections were calculated probabilistically using microsimulation. Mortality hazard rates for each Fontan recipient were calculated from survivorship of 1353 Fontan recipients in the Australia and New Zealand Fontan Registry, based on Fontan type, age at Fontan, gender and morphology. Projected rates of new Fontan procedures were generated from historical rates of Fontan procedures per population births.
  
  
  RESULTS
  At the end of 2014, the living Fontan population of Australia and New Zealand was 1265 people from an Australian and New Zealand regional population of 28 million (4.5 per 100,000 population). Of those, 165 (13%) received an atrio-pulmonary (AP) procedure, 262 (21%) a lateral tunnel (LT) procedure and 838 (66%) an extra-cardiac conduit (ECC) procedure. This population is expected to grow to 1917 (95% CI: 1846: 1986) by 2025 (5.8 per 100,000 population), with 149 (8%) AP procedures, 254 (13%) LT procedures, and 1514 (79%) ECC procedures. By 2045, the living Fontan population is expected to reach 2986 (95% CI: 2877: 3085; 7.2 per 100,000 population). The average age of the Fontan population is expected to increase from 18years in 2014 to 23years (95% CI: 22-23) by 2025, and 31years (95% CI: 30-31) by 2045.
  
  
  CONCLUSIONS
  The Australian and New Zealand population of patients alive after a Fontan procedure will double over the next 20years increasing the demand for heart-failure services and cardiac transplantation. Greater consideration for the needs of this mostly adult Fontan population will be necessary.
authors.affiliation: Centre for Health Policy, The University of Melbourne, 207 Bouverie St Carlton, Victoria 3051, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Schilling
authors.affiliation: Centre for Health Policy, The University of Melbourne, 207 Bouverie St Carlton, Victoria 3051, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Dalziel
authors.affiliation: Department of Cardiac Surgery, Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia.
authors.forename: Russell
authors.initials: R
authors.lastname: Nunn
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors.forename: Karin
authors.initials: K
authors.lastname: Du Plessis
authors.affiliation: Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: William Y
authors.initials: WY
authors.lastname: Shi
authors.affiliation: Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Department of Medicine, The University of Sydney, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Celermajer
authors.affiliation: Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Winlaw
authors.affiliation: Department of Cardiology, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Weintraub
authors.affiliation: Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Leanne E
authors.initials: LE
authors.lastname: Grigg
authors.affiliation: Adult Congenital Heart Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia; Department of Medicine, University of Queensland, Brisbane, Australia.
authors.forename: Dorothy J
authors.initials: DJ
authors.lastname: Radford
authors.affiliation: Children's Cardiac Centre, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bullock
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital Auckland, Auckland, New Zealand.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Gentles
authors.affiliation: Department of Cardiology, Women's and Children's Hospital, Adelaide, South Australia, Australia.
authors.forename: Gavin R
authors.initials: GR
authors.lastname: Wheaton
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital Auckland, Auckland, New Zealand.
authors.forename: Tim
authors.initials: T
authors.lastname: Hornung
authors.affiliation: Queensland Paediatric Cardiac Service, Lady Cilento Children's Hospital, Queensland, Australia.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Justo
authors.affiliation: Department of Cardiac Surgery, Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052, Australia; Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia. Electronic address: yves.dudekem@rch.org.au.
authors.forename: Yves
authors.initials: Y
authors.lastname: d'Udekem
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D002648:Child; D005260:Female; D018729:Fontan Procedure / Q000401:mortality* / Q000639:trends*; D006801:Humans; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D000069457:Population Forecast / Q000379:methods*; D012042:Registries; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
keywords: Congenital heart disease; Fontan procedure; Modelling; Survival