Open AccessIschemic Stroke in Adults With Congenital Heart Disease: A Population‐Based Cohort Study
Author(s) -
Pedersen Mette Glavind Bülow,
Olsen Morten S.,
Schmidt Morten,
Johnsen Søren P.,
Learn Christopher,
Laursen Henning B.,
Madsen Nicolas L.
Publication year - 2019
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.118.011870
Subject(s) - medicine , hazard ratio , stroke (engine) , cohort , population , cohort study , proportional hazards model , pediatrics , heart disease , confidence interval , mechanical engineering , environmental health , engineering
Background Congenital heart disease ( CHD ) is associated with risk factors for ischemic stroke including cardiac arrhythmias and heart failure. However, few long‐term follow‐up data exist on ischemic stroke risk and associated mortality in adults with CHD . Methods and Results Using Danish nationwide registries, we identified individuals aged ≥18 years diagnosed with CHD , at any age, from 1963 to 2017 and a sex and birth year‐matched (1:10) general population comparison cohort. We computed risks, as well as sex and birth year‐adjusted hazard ratios ( aHR s) for ischemic stroke and 30‐day post‐stroke mortality in CHD adults compared with the general population. Analyses were stratified according to age <60 years (young) and ≥60 years (older). We identified 16 836 adults with CHD . The risk of ischemic stroke at age 60 years was 7.4% in the CHD cohort and 2.9% in the general population cohort. The adjusted hazard ratios for ischemic stroke compared with the general population was 3.8 (95% CI : 3.3–4.3) in young CHD adults and 1.6 (95% CI : 1.4–1.9) in older CHD adults. The adjusted hazard ratios for post‐stroke mortality compared with the general population was 2.3 (95% CI : 1.2–4.4) in young CHD adults and 1.3 (95% CI : 0.9–1.9) in older CHD adults. Conclusions Both younger and older CHD adults have an increased risk of ischemic stroke and by 60 years of age 7.4% of CHD adults will have had an ischemic stroke. Post‐stroke mortality was also increased in CHD adults compared with the general population.