Nichtkardiale Komorbiditäten bei erwachsenen Patienten mit angeborenen Herzfehlern: Häufigkeit und gesundheitspolitische Bedeutung

Background: Due to improved treatment strategies, the number of patients with congenital heart disease (CHD) reaching adulthood is continuously increasing. Non-cardiac comorbidities are of increasing importance because they influence the course of the underlying cardiac disease or because the course of the comorbidity becomes modified. Objective: The study was carried out to investigate non-cardiac comorbidities in adult patients with CHD and the medical and healthcare political relevance are discussed. Patients and methods: In a tertiary care center for CHD, 821 consecutive adults who were treated in the outpatient clinic participated in the study. Cardiac diagnoses, interventional and surgical measures, clinical status and non-cardiac comorbidities were documented. Results: The patient collective represented all types and grades of severity of cyanotic and acyanotic CHD. In 95.2% of the adults with CHD, significant non-cardiac comorbidities were apparent, which could be assigned to 16 medical specialist fields. The diseases were so severe that they necessitated treatment or influenced the course and/or therapy approach to the underlying cardiac disease. The most frequent comorbidities were endocrinological (41.9%), neurological (18%), gastroenterological (30.8%) and psychiatric diseases (6.3%). More than 10% of adult patients with CHD had a syndromic or genetic disease. Conclusion: Non-cardiac comorbidities are very common in adults with CHD and have an influence on the long-term course. The study underlines the necessity of developing screening and management programs for non-cardiac comorbidities, to create a multidisciplinary concept for diagnosis and therapy to improve the management and quality of life in adults with CHD. A prerequisite is a close and coordinated collaboration between the cardiologists treating the CHD and various other medical specialties.