Comorbidity burden high among adolescents with congenital heart disease

Adolescents with congenital heart disease (CHD) have increased risks of both cardiac and noncardiac comorbidities, according to a recent study published in Pediatrics Open Science.¹

Improved survival has been reported in children with CHD, leading more to reach adolescence and transition into adulthood, a period which has been recognized as leading to increased vulnerability. This increases the risks of comorbidities such as anxiety, depression, and cardiometabolic risk factors.²

“For a group that accounts for approximately 1 in 150 adolescents in the general population, information on the comorbidity profile of adolescents with CHD, compared with children and adults, is scarce, particularly from population-based studies,” wrote investigators.¹

CHD and comorbidity assessment

The retrospective cohort study was conducted to evaluate the frequency, patterns, and sociodemographic factors linked to cardiac and noncardiac events in pediatric patients aged 11 to 18 years. Residents of a study area between January 1, 2011, and December 31, 2013, with at least 1 health encounter involving CHD were included in the analysis.

CHD was determined based on diagnostic codes in the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) system. Based on these groups, patient CHD was classified as either severe, shunt, valve, shunt-valve, or “other.” Patients with multiple codes were classified as severe if at least 1 fit this description.

The current analysis excluded individuals in the “other” category, as the positive predictive value for identifying a true CHD was low among these patients. A Clinical Classifications Software system was used to categorize ICD-9-CM diagnoses based on comorbidity type. These categories were condensed in 26 groups.

Comorbidities were categorized as cardiac-related or noncardiac-related. Long-term mortality was predicted using the Charlson score. Covariates included race and ethnicity, sex, age at first qualifying encounter, study site, and insurance type.

Patient characteristics and comorbidity burden

There were 9626 adolescents aged 11 to 18 years with CHD included in the analysis, 26% of whom had severe CHD and 43% valve lesions. Patients were aged a mean 14 years, with 44% being female, 15% Black, 2% multiracial, and 15% Hispanic. Public insurance was reported in 43% and a Charlson Comorbidity Index of at least 1 in 22%.

Presenting with at least 1 comorbidity was reported among 68% of the cohort, while 2 or more were reported in 46%. Factors linked to having a comorbidity included CHD severity, race, and insurance type. Comorbidity rates were increased among patients with severe vs shunt CHD.

A rate of 55% was reported for noncardiac comorbidities vs 40% for cardiac comorbidities. However, distribution of cardiac vs noncardiac comorbidities differed between CHD severity groups. Both types were greatest among the severe group, with a rate of 54.6% for cardiac comorbidities and 65% for noncardiac comorbidities.

Common cardiac and noncardiac comorbidities

Residual cardiac disease was reported in 27.3% of patients and arrhythmias in 14.4%, making them the most common type of cardiac comorbidities. In comparison, 6.3% of patients presented with heart failure, though the rate was 2-fold greater in patients with severe CHD vs other types.

Psychiatric conditions were the most common noncardiac comorbidities, observed in 20.4% of participants. This was followed by obstructive pulmonary disease, nutrition-related conditions, and endocrine disorders, with rates of 13.4%, 11.7%, and 7.1%, respectively.

These results highlighted the spectrum, frequency, and patterns of cardiac and noncardiac comorbidities among adolescents with CHD. Investigators concluded residual cardiac disease, arrhythmias, neurodevelopmental and psychiatric conditions, and endocrine and nutritional conditions are the primary concerns.

“This information may help improve preventive and care strategies for this vulnerable population and reinforce the importance of a smooth and comprehensive transition from pediatric to adult medical care for adolescents with CHD,” wrote investigators.

References

1. Reeder MR, Botto LD, Lui GK, et al. Comorbidities in adolescents with congenital heart disease: a population-based study. Pediatrics Open Science. 2025;1(4):1-12. doi:10.1542/pedsos.2025-000967
2. Lui GK, Saidi A, Bhatt AB, et al. Diagnosis and management of noncardiac complications in adults with congenital heart disease: a scientific statement from the American Heart Association. Circulation. 2017;136(20):e348-e392. doi:10.1161/CIR.0000000000000535