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

Julie Billett ^1*, Azeem Majeed ¹, Michael A Gatzoulis ² and Martin Cowie ³

¹ Imperial College London, United Kingdom
² Professor of Cardiology (Congenital Heart Disease), Royal Brompton Hospital, United Kingdom
³ National Heart and Lung Institute, United Kingdom

^* To whom correspondence should be addressed. E-mail: juliebillett{at}yahoo.co.uk.

Accepted 11 June 2007

Abstract

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-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 1995/96 and 2003/04 the age standardised hospital admission rate for CHD increased from 30.7 per 100,000 (95% CI 29.9-31.4) to 35.5 per 100,000 (95% CI 34.7-36.4) in males and from 28.2 per 100,000 (95% CI 27.4-28.9) to 32.8 per 100,000 (95% CI 32.0-33.6) in females. Between 1997/98 and 2003/04 in-hospital case fatality rates fell from 2.10% (95% CI 1.97-2.22) to 0.83% (95% CI 0.74-0.92). Population mortality fell steadily over the decade 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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