Congenital Heart Disease Mortality Highest in Infants, Emphasizing Need for Specialized Care – HCPLive

Report on Congenital Heart Disease Mortality and its Implications for Sustainable Development Goal 3

A recent population-based study provides critical data on mortality rates and causes of death among individuals with Congenital Heart Disease (CHD), highlighting significant challenges and opportunities related to the United Nations Sustainable Development Goal 3 (SDG 3): Good Health and Well-being.

Study Overview and Methodology

The findings originate from the Center for Disease Control’s STAR1 registry, a comprehensive U.S. population-based study. The analysis included data from 2010-2019 across seven states.

• Cohort Size: 218,863 patients aged 0-45 years.
• Classification: Patients were categorized as having either severe CHD (sevCHD) or nonsevere CHD (nsCHD).
• Data Collection: Mortality data and underlying causes of death were sourced from state death certificates and birth defect registries.

Key Findings in the Context of SDG 3

The study’s results underscore the urgent need for targeted health interventions across the lifespan for individuals with CHD, directly aligning with several targets under SDG 3.

Infant and Child Mortality (SDG Target 3.2)

The research reveals that mortality remains highest during infancy for both sevCHD and nsCHD, a critical concern for SDG Target 3.2, which aims to end preventable deaths of newborns and children under five years of age.

1. High Infant Mortality Rate: The study period saw the death of 11% of infants with sevCHD and 2% of infants with nsCHD.
2. Proportion of Deaths: Infant deaths accounted for approximately 60% of all deaths in the sevCHD group and 55% in the nsCHD group, indicating that the first year of life is the period of highest risk.
3. Disparity in Severity: The mortality rate for sevCHD was uniformly higher than for nsCHD across all age groups, beginning in infancy.

Premature Mortality from Non-Communicable Diseases (SDG Target 3.4)

The lifelong health challenges faced by CHD survivors and the evolving causes of death with age are directly relevant to SDG Target 3.4, which focuses on reducing premature mortality from non-communicable diseases (NCDs) through prevention and treatment.

• Overall Mortality: 7.6% of the sevCHD cohort died during the study period, compared to 2.1% of the nsCHD cohort.
• Causes of Death in Severe CHD (sevCHD):
  • In younger patients, death was primarily attributed to CHD itself.
  • With increasing age, a combination of CHD and acquired cardiovascular diseases became the leading causes. By age 40, these accounted for approximately 80% of deaths.
  • Heart failure (HF) was identified as the most common non-CHD cardiac cause of death, increasing significantly with age.
• Causes of Death in Nonsevere CHD (nsCHD):
  • Non-cardiac diseases were the most common cause of death until age 30.
  • In patients over 30 years, acquired cardiovascular diseases became the predominant cause of death.

Conclusion: Advancing SDG 3 Through Specialized Healthcare

The study concludes by emphasizing the dual need for specialized CHD care and proactive cardiovascular preventive care throughout the lives of patients. This conclusion strongly supports the framework of SDG 3, particularly the push for universal health coverage (Target 3.8) that provides access to quality, specialized health services. Addressing the high mortality in infancy and managing the lifelong risk of acquired cardiovascular disease are essential to making progress on global health and well-being targets.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The entire article is centered on health issues, specifically the mortality rates and causes of death associated with Congenital Heart Disease (CHD). It discusses morbidity, mortality, and the need for specialized and preventive healthcare, which are core components of SDG 3. The research presented aims to understand and ultimately reduce deaths from this non-communicable disease, directly aligning with the goal of ensuring healthy lives and promoting well-being for all at all ages.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.2: End preventable deaths of newborns and children under 5 years of age.
   • The article explicitly states that “Congenital heart disease (CHD) mortality is still at its highest in infancy.” It provides data showing that a significant percentage of deaths occurred in infants: “11% of infants with sevCHD and 2% of infants with nsCHD died, which accounted for roughly 60% and 55% of all deaths in each severity group.” This focus on infant mortality directly relates to the goal of reducing deaths in newborns and young children.
2. Target 3.4: Reduce by one-third premature mortality from non-communicable diseases through prevention and treatment.
   • CHD is a non-communicable disease (NCD). The article analyzes mortality rates from CHD and related cardiovascular conditions across the lifespan (up to age 45). It notes that for patients over 40, “CHD and acquired cardiovascular disease were the cause of death in 80% of patients.” The conclusion emphasizes “the need for specialized CHD care and an emphasis on [cardiovascular] preventive care throughout the lives of CHD patients,” which directly supports the prevention and treatment aspect of this target.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicators for Target 3.2 (Under-5 and Neonatal Mortality):
   • The article provides data that serves as a direct indicator for infant mortality. It calculates mortality rates (MRs) as “deaths per 100,000 live births in infants.” The finding that 11% of infants with severe CHD and 2% with non-severe CHD died during the study period are specific metrics that can be used to track progress in reducing infant mortality from this specific cause.
2. Indicators for Target 3.4 (Mortality from NCDs):
   • The article uses “deaths per 100,000 person-years in non-infants” to measure mortality, which aligns with the SDG indicator 3.4.1 (Mortality rate attributed to cardiovascular disease…). It provides specific data points, such as the mortality rate from Heart Failure (HF) rising from “9 in 100,000 in 11-20 year olds to 197 in 100,000 in 41+ year olds.” This quantifies the premature mortality rate from a specific cardiovascular NCD within the studied population.

4. Table of SDGs, Targets, and Indicators

Source: hcplive.com