EPIDEMIOLOGY

Trends in hospital admissions, in-hospital case fatality and population mortality from congenital heart disease in England, 1994 to 2004

J Billett¹, A Majeed², M Gatzoulis³ and M Cowie⁴

¹ Imperial College London, Department of Primary Care and Social Medicine, Imperial College London, UK
² Department of Primary Care and Social Medicine, Imperial College London, London, UK
³ Royal Brompton Hospital, Sydney Street, London, UK
⁴ National Heart and Lung Institute, London, UK

Correspondence to:
Julie Billett, Specialist Trainee in Public Health and Honorary Research Fellow, Imperial College London, Department of Primary Care and Social Medicine, Imperial College London, Charing Cross Campus, Reynolds Building, St Dunstan’s Road, London W6 8RD, UK; juliebillett{at}yahoo.co.uk

Objective: To ascertain time trends in rates of hospital admission, operations, in-hospital case fatality and general mortality for congenital heart disease (CHD) in England and Wales.

Design: Retrospective analysis of Hospital Episodes Statistics for England (April 1995 to March 2004) and mortality statistics for England and Wales (1994–2003).

Population: All NHS patients admitted with a primary diagnosis of CHD to hospitals in England, and all deaths in England and Wales with an underlying cause of CHD.

Main outcome measures: Age-standardised hospital admission rates, case fatality rates and death rates from congenital heart disease.

Results: Between 1995/1996 and 2003/2004 the age-standardised hospital admission rate for CHD increased from 30.7 per 100 000 (95% CI 29.9 to 31.4) to 35.5 per 100 000 (95% CI 34.7 to 36.4) in men and boys and from 28.2 per 100 000 (95% CI 27.4 to 28.9) to 32.8 per 100 000 (95% CI 32.0 to 33.6) in women and girls. Between 1997/1998 and 2003/2004 in-hospital case fatality rates fell from 2.10% (95% CI 1.97 to 2.22) to 0.83% (95% CI 0.74 to 0.92). Population mortality fell steadily over the decade from 1994 to 2003 in men and women, with the largest proportionate decrease in the 1–4-year age group.

Conclusion: Admission rates for CHD have increased over the past decade, particularly amongst patients in older age groups. There has also been a significant decrease in both in-hospital case fatality rates and in general population mortality rates. These trends are consistent with improvements in the quality of care for these patients, improvements in survival and the predicted expansion in the number of adults living with CHD.

Keywords: congenital heart disease; hospital admissions; mortality; time trends

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