Atrial septal defect patients have an elevated risk for infective endocarditis

Abstract

Background. It has been unclear whether simple atrial septal defect (ASD) is an independent risk factor for infective endocarditis (IE). This study aimed to untangle the risk of endocarditis in a large nationwide cohort. Methods. We acquired data from the Finnish hospital discharge register on all individuals with ASD diagnosis from 1969 to 2019. Patients with complex congenital cardiac abnormalities were ruled out. Five individualized controls from the general population were matched to the ASD patient’s birth year, sex, and residence at the index date. All the patients with ICD-8, −9, or −10 diagnosis codes for IE were gathered from the hospital discharge registry. Results. Altogether, 8322 patients with ASD and 39,237 individualized controls were enrolled in the study. Median follow-up was 21.6 years (IQR 11.8–36.9) from the first hospital contact. In total, 24 (16 male) cases of infective endocarditis among ASD patients and 10 (8 male) cases among controls were diagnosed during the follow-up. The incidence of endocarditis was 0.11 per 1000 person-years in the patients with ASD and 0.011 per 1000 person-years in the controls. The adjusted risk ratio for endocarditis was 13.51 (95% CI: 6.20–29.46) in patients with ASD compared to the control cohort. Patients with ASD and endocarditis had higher long-term mortality than individualized control patients (MRR 2.25, 95% CI: 1.23–4.11). Conclusions. The incidence of IE in patients with ASD was higher than in the general population. Mortality associated with IE was higher in patients with ASD compared to controls.

Keywords:

• Atrial septal defect
• endocarditis
• congenital heart disease

Ethics statement

The Helsinki University hospitals ethics committee approved this study on 11.7.2019 (num. HUS/1820/2019), and it was conducted following the Declaration of Helsinki. Patient consent was not needed for register-based research.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data supporting our findings are available from Statistics Finland and the FHDR. Still, restrictions apply to data availability, which was used under license for the current research and is not publicly available. Data are, however, available from the authors upon reasonable request and with permission from Statistics Finland and the FHDR.

Additional information

Funding

This work was supported by the Emil Aaltosen Foundation, Päivikki and Sakari Sohlberg Foundation, and The Foundation for Pediatric Research.