Trends of mortality rate in patients with congenital heart defects in Germany-analysis of nationwide data of the Federal Statistical Office of Germany

Abstract

Background Congenital heart defects (CHD) are still associated with an increased morbidity and mortality. The aim of this study was to analyze trends of mortality rates in patients with CHD between 1998 and 2018 in Germany. Methods Data of registered deaths with an underlying diagnosis of CHD were used to evaluate annual mortality between 1998 and 2018. Polynomial regressions were performed to assess annual changes in CHD-associated mortality rates by age groups. Results During the 21-year study period, a total of 11,314 deaths were attributed to CHD with 50.9% of deaths in infants (age<1 year) and 28.2% in neonates (age≤28 days). The most frequent underlying CHDs associated with death were hypoplastic left heart syndrome (n=1498, 13.2%), left ventricular outfow tract obstruction (n=1009, 8.9%), atrial septal defects (n=771, 6.8%), ventricular septal defects (n=697, 6.2%), and tetralogy of Fallot (n=673, 5.9%), and others (n=6666, 58.9%). Among all patients, annual CHD-related mortality rates declined signifcantly between 1998 and 2010 (p<0.0001), followed by a signifcant annual increase until 2018 (p<0.0001). However, mortality rates in 2018 in all ages were signifcantly lower than in 1998. Conclusion Mortality in CHD patients decreased signifcantly between 1998 and 2010, but a substantial number of deaths still occurred and even signifcantly increased in the last 3 years of the observation period particularly in neonates and infants. This renewed slight increase in mortality rate during the last years was infuenced mainly by high-risk neonates and infants. Assessment of factors infuencing the mortality rate trends in association with CHD in Germany is urgently needed. Obligatory nationwide registration of death cases in relation to surgical and catheter interventions in CHD patients is necessary to provide additional valuable data on the outcome of CHD.