- Design
- Retrospective single-centre cohort
- Population
- 9,826 adults with congenital heart disease, mean age 39, one tertiary centre, 2000 to 2024
- Primary outcome
- All-cause mortality
- Effect
- Sleep apnoea HR 2.22, coronary disease HR 1.78, smoking HR 1.67, depression HR 1.45, lesion complexity HR 2.12
A single tertiary centre analysed 9,826 adults with congenital heart disease (mean age 39) seen between 2000 and 2024. Over a median 10 years, 1,371 died, a mortality rate of 1.39% per patient-year.
Lesion complexity remained a strong predictor (HR 2.12). Alongside it, several acquired conditions were independently associated with death: sleep apnoea (HR 2.22), coronary artery disease (HR 1.78), current smoking (HR 1.67) and depression (HR 1.45). Higher income was associated with lower mortality.
As survival into middle age becomes usual, these patients accumulate the same risks as everyone else, on top of their congenital lesion. Clinic time tends to go on the anatomy; this cohort argues for routinely screening the rest.
- Ask every adult with congenital heart disease about smoking, and offer cessation support.
- Screen for sleep apnoea symptoms, and refer for a sleep study where they are present.
- Check mood at review; depression was independently associated with higher mortality.
- Manage lipids, blood pressure and glucose as for any adult at their risk level.
Why it matters
Congenital clinics that focus only on the lesion may be missing the risks now driving late deaths.
Don't overread it
These are associations from one specialist centre; they do not show that treating sleep apnoea or depression lowers mortality in this group.
The statistics, in plain English
Hazard ratios here come from one model including all factors at once, so each is adjusted for the others. A hazard ratio of 2.22 for sleep apnoea means roughly twice the death rate among those with it, after accounting for age, sex and lesion complexity.
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