TY - JOUR
T1 - Epidemiological changes in Eisenmenger syndrome in the Nordic region in 1977-2012
AU - Hjortshøj, Cristel Sørensen
AU - Jensen, Annette Schophuus
AU - Sørensen, Keld
AU - Nagy, Edit
AU - Johansson, Bengt
AU - Kronvall, Thomas
AU - Dellborg, Mikael
AU - Estensen, Mette-Elise
AU - Holmstrøm, Henrik
AU - Turanlahti, Maila
AU - Thilén, Ulf
AU - Søndergaard, Lars
N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
PY - 2017
Y1 - 2017
N2 - Objective Improved diagnostic tools, timely closure of the shunt and a better understanding of the complexity of Eisenmenger syndrome (ES) have led to improved care and treatment in tertiary centres. These may have decreased the incidence of ES and improved survival of patients with ES, although evidence is still lacking. The aim of this study was to investigate temporal changes in incidence, prevalence and mortality in patients with ES for 35 years in the Nordic region. Methods This was a retrospective population-based study including 714 patients with ES. Survival analysis was performed based on all-cause mortality and accounting for immortal time bias. Results The incidence of ES decreased from 2.5/million inhabitants/year in 1977 to 0.2/million inhabitants/year in 2012. Correspondingly, prevalence decreased from 24.6 to 11.9/million inhabitants. The median survival was 38.4 years, with 20-year, 40-year and 60-year survival of 72.5%, 48.4%, and 21.3%, respectively. Complex lesions and Down syndrome were independently associated with worse survival (HR 2.2, p<0.001 and HR 1.8, p<0.001, respectively). Age at death increased from 27.7 years in the period from 1977 to 1992, to 46.3 years from July 2006 to 2012 (p<0.001). Conclusions The incidence and prevalence of ES in the Nordic region have decreased markedly during the last decades. Furthermore, the median age at death increased throughout the study period, indicating prolonged life expectancy in the ES population. However, increasing age represents decreased incidence, rather than improved survival. Nonetheless, longevity with ES is still shorter than in the background population.
AB - Objective Improved diagnostic tools, timely closure of the shunt and a better understanding of the complexity of Eisenmenger syndrome (ES) have led to improved care and treatment in tertiary centres. These may have decreased the incidence of ES and improved survival of patients with ES, although evidence is still lacking. The aim of this study was to investigate temporal changes in incidence, prevalence and mortality in patients with ES for 35 years in the Nordic region. Methods This was a retrospective population-based study including 714 patients with ES. Survival analysis was performed based on all-cause mortality and accounting for immortal time bias. Results The incidence of ES decreased from 2.5/million inhabitants/year in 1977 to 0.2/million inhabitants/year in 2012. Correspondingly, prevalence decreased from 24.6 to 11.9/million inhabitants. The median survival was 38.4 years, with 20-year, 40-year and 60-year survival of 72.5%, 48.4%, and 21.3%, respectively. Complex lesions and Down syndrome were independently associated with worse survival (HR 2.2, p<0.001 and HR 1.8, p<0.001, respectively). Age at death increased from 27.7 years in the period from 1977 to 1992, to 46.3 years from July 2006 to 2012 (p<0.001). Conclusions The incidence and prevalence of ES in the Nordic region have decreased markedly during the last decades. Furthermore, the median age at death increased throughout the study period, indicating prolonged life expectancy in the ES population. However, increasing age represents decreased incidence, rather than improved survival. Nonetheless, longevity with ES is still shorter than in the background population.
KW - Adult
KW - Cause of Death/trends
KW - Eisenmenger Complex/epidemiology
KW - Female
KW - Follow-Up Studies
KW - Forecasting
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Population Surveillance/methods
KW - Prevalence
KW - Registries
KW - Retrospective Studies
KW - Risk Assessment/methods
KW - Scandinavian and Nordic Countries/epidemiology
KW - Survival Rate/trends
U2 - 10.1136/heartjnl-2016-310979
DO - 10.1136/heartjnl-2016-310979
M3 - Journal article
C2 - 28450553
SN - 1355-6037
VL - 103
SP - 1353
EP - 1358
JO - Heart
JF - Heart
IS - 17
ER -
