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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Incidence of Stroke in Adults With Congenital Heart Disease: A Systematic Review and Meta-Analysis
Amanda E Bilski1, Jonathan Kochav2, Greer Waldrop3
1Columbia University Medical Center, Department of Neurology, New York, New York, USA; New York University School of Medicine, Department of Neurology, New York, New York, USA.
Insights
Adults with congenital heart disease (ACHD) face a higher risk of stroke and transient ischemic attack (TIA). This meta-analysis found a pooled incidence rate of 0.58 per 100 person-years for stroke and TIA in the ACHD population.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Congenital heart disease (CHD) is a known risk factor for cerebrovascular events.
- Adults with congenital heart disease (ACHD) represent a growing population with unique health concerns.
Purpose of the Study:
- To determine the incidence rate of stroke and transient ischemic attack (TIA) in adults with congenital heart disease (ACHD).
- To synthesize existing evidence on cerebrovascular event incidence within the ACHD population.
Main Methods:
- A systematic review and meta-analysis were conducted following PRISMA guidelines.
- Studies reporting stroke or TIA incidence in individuals aged 16 years and older with ACHD were included.
- Random-effects meta-analysis estimated the pooled incidence rate, with risk of bias assessed using the Newcastle-Ottawa Scale.
Main Results:
- Twenty-seven studies comprising 39 incidence rate estimates were included in the meta-analysis.
- The pooled incidence rate for stroke and TIA in ACHD was 0.58 per 100 person-years (95% CI: 0.39-0.86).
- The incidence rate for ischemic stroke was estimated at 0.59 per 100 person-years (95% CI: 0.36-0.95).
Conclusions:
- This meta-analysis quantifies the incidence of stroke and TIA in the ACHD population.
- Further high-quality research is essential to identify high-risk ACHD patients and develop primary stroke prevention strategies.
Background:
Congenital heart disease is associated with an increased risk of cerebrovascular events.
Objectives:
The authors investigated the incidence of stroke and transient ischemic attack (TIA) in adults with congenital heart disease (ACHD).
Methods:
A systematic review was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all studies reporting the incidence of stroke and TIA in ACHD. Two independent reviewers screened studies, which were included if patients were of age 16 years or older with congenital heart disease and if the outcome was stroke or TIA. Random-effects meta-analysis was conducted to estimate the pooled incidence rate of stroke and TIA with 95% CIs. The Newcastle-Ottawa Scale for Risk of Bias was applied. This systematic review is registered (CRD42022322144).
Results:
Of 11,028 identified abstracts, 27 studies met inclusion criteria. Twenty-one studies reported mean or median age, which was <60 years in 19 studies. Thirty-nine estimates of incidence rates from 24 studies were entered in the meta-analysis. The pooled incidence rate estimate of stroke and TIA was 0.58 per 100 person-years, with significant heterogeneity between studies (95% CI: 0.39-0.86; I2: 97.8%; P < 0.001). Secondary analyses were performed stratified by outcome subtype. The pooled incidence rate of ischemic stroke was estimated at 0.59 per 100 person-years (95% CI: 0.36-0.95; I2: 98%; P = 0.01).
Conclusions:
This meta-analysis describes the incidence rate of stroke and TIA in the ACHD population. High-quality studies are needed to identify which ACHD patients are at the highest risk and to develop effective strategies for primary stroke prevention in this population.
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