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Trends in presentation of congenital heart disease in a population-based study in Malta
1Paediatric Department, St. Luke's Hospital, Guardamangia, Malta. victor.e.grech@magnet.mt
Insights
Congenital heart disease diagnoses increased from 1960-1994, with more cases identified before hospital discharge. Pediatrician referrals rose, while general practitioner referrals declined for pediatric heart conditions.
Area of Science:
- Cardiology
- Pediatrics
- Public Health
Background:
- Congenital heart disease (CHD) presentation varies based on pathological hemodynamics.
- Historical trends in CHD presentation require population-based analysis.
Purpose of the Study:
- To identify historical trends in the presentation of congenital heart disease in Malta from 1960 to 1994.
- To analyze changes in referral sources, presentation modes, and birth prevalence of CHD.
Main Methods:
- Population-based study including 868 patients diagnosed with CHD in Malta (1960-1994).
- Analysis of referral trends from general practitioners and pediatricians.
- Examination of presentation modes and lesion-specific diagnostic timing.
Main Results:
- The number of diagnosed CHD cases increased over the study period.
- Proportion of diagnoses made before hospital discharge significantly increased for both interventional and non-interventional cases.
- General practitioner referrals decreased, while pediatrician referrals increased; pediatricians referred more cases for cyanosis or heart failure.
Conclusions:
- Increased hospital deliveries and improved neonatal examination practices contribute to more in-hospital CHD diagnoses.
- The rise in pediatrician diagnoses is linked to an expanding pediatrician pool and enhanced parental awareness.
- Shifting referral patterns reflect changes in healthcare access and specialist involvement in pediatric cardiology.
Abstract:
Differing pathological haemodynamics in cardiac malformations lead to varying modes and timings of presentation. This study identifies historical trends in presentation of congenital heart disease in a population-based study. All patients diagnosed as having congenital heart disease in Malta between 1960-1994 were included (n = 868). Analysis was carried out on trends in referral sources, modes of presentation and birth prevalence. The number of patients diagnosed with congenital heart disease increased over the period under study. For both patients not requiring intervention (n = 283) and those requiring intervention (n = 585), the proportion diagnosed prior to hospital discharge increased (p < or = 0.005). There was a decreasing trend for general practitioners to refer cases (p < 0.0001), and an increasing trend for paediatricians to refer such patients (p < or = 0.0003). The commonest presentation to the general practitioner was an incidental finding (92%), while paediatricians referred more patients for cyanosis or heart failure (p < or =, 0.005). For lesions not requiring intervention, the commonest lesion referred was ventricular septal defect from all sources. For lesions requiring intervention, the commonest lesion detected prior to hospital discharge was tetralogy of Fallot. Atrial septal defects were the commonest lesions detected after discharge by both paediatricians and general practitioners. An increase in the proportion of hospital diagnoses is attributed to increasing rate of hospital delivery, and greater training and experience in doctors performing neonatal examinations prior to discharge. Patients diagnosed after discharge are increasingly diagnosed by paediatricians due to an increasing pool of paediatricians and better parent awareness and education.