Cause-Specific Mortality of Patients With Atrial Septal Defect and Up to 50 Years of Follow-Up

Abstract

BACKGROUND: This study aimed to evaluate the long-term mortality and cause-specific mortality of patients with atrial septal defect (ASD) in a nationwide cohort. METHODS AND RESULTS: All patients diagnosed with simple ASD in the hospital discharge registry from 1969 to 2019 were included in the study. Complex congenital defects were excluded. Each subject was matched with 5 controls according to sex, age, and municipality at the index time. Adjusted mortality risk ratios (MRRs) were calculated using Poisson regression models. The median follow-up time was 11.1 years. Patients with ASD had higher overall mortality during follow-up, with an adjusted MRR of 1.72 (95% CI, 1.61–1.83). Patients with closed ASDs also had higher total mortality (MRR, 1.29 [95% CI, 1.10–1.51]). However, no difference in mortality was detected if the defect was closed before the age of 30 (MRR, 1.58 [95% CI, 0.90–2.77]), and transcatheter closed defects had lower mortality than the control cohort (MRR, 0.65 [95% CI, 0.42–0.99]). Patients with ASD had significantly more deaths due to congenital malformations (MRR, 54.61 [95% CI, 34.03–87.64]), other diseases of the circulatory system (MRR, 2.90 [95% CI, 2.42–3.49]), stroke (MRR, 1.89 [95% CI, 1.52–2.33]), diseases of the endocrine (MRR, 1.88 [95% CI, 1.10–3.22]) and respiratory system (MRR, 1.71 [95% CI, 1.19–2.45]), ischemic heart disease (MRR, 1.62 [95% CI, 1.41–1.86]), and accidents (MRR, 1.41 [95% CI, 1.05–1.89]). CONCLUSIONS: Patients with ASD had higher overall mortality compared with a matched general population cohort. Increased cause-specific mortality was seen in congenital malformations, stroke, and heart diseases.