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      Epidemiology of congenital heart disease in Brazil Translated title: Epidemiologia da cardiopatia congênita no Brasil

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          Abstract

          Introduction

          Congenital heart disease is an abnormality in the structure or cardiocirculatory function, occurring from birth, even if diagnosed later. It can result in intrauterine death in childhood or in adulthood. Accounted for 6% of infant deaths in Brazil in 2007.

          Objective

          To estimate underreporting in the prevalence of congenital heart disease in Brazil and its subtypes.

          Methods

          The calculations of prevalence were performed by applying coefficients, giving them function rates for calculations of health problems. The study makes an approach between the literature and the governmental registries. It was adopted an estimate of 9: 1000 births and prevalence rates for subtypes applied to births of 2010. Estimates of births with congenital heart disease were compared with the reports to the Ministry of Health and were studied by descriptive methods with the use of rates and coefficients represented in tables.

          Results

          The incidence in Brazil is 25,757 new cases/year, distributed in: North 2,758; Northeast 7,570; Southeast 10,112; South 3,329; and Midwest 1,987. In 2010, were reported to System of Live Birth Information of Ministry of Health 1,377 cases of babies with congenital heart disease, representing 5.3% of the estimated for Brazil. In the same period, the most common subtypes were: ventricular septal defect (7,498); atrial septal defect (4,693); persistent ductus arteriosus (2,490); pulmonary stenosis (1,431); tetralogy of Fallot (973); coarctation of the aorta (973); transposition of the great arteries (887); and aortic stenosis 630. The prevalence of congenital heart disease, for the year of 2009, was 675,495 children and adolescents and 552,092 adults.

          Conclusion

          In Brazil, there is underreporting in the prevalence of congenital heart disease, signaling the need for adjustments in the methodology of registration.

          Translated abstract

          Introdução

          Cardiopatia congênita é uma anormalidade na estrutura ou função cardiocirculatória, ocorrente desde o nascimento, mesmo que diagnosticada posteriormente. Pode resultar em morte intraútero, na infância ou na idade adulta. Foi responsável por 6% dos óbitos infantis, no Brasil, em 2007.

          Objetivo

          Estimar a subnotificação na prevalência das cardiopatias congênitas no Brasil e seus subtipos.

          Métodos

          Os cálculos das prevalências foram realizados aplicando-se coeficientes, atribuindo-lhes função de taxas para cálculos dos agravos. O estudo faz aproximação entre a literatura e os registros governamentais. Adotou-se estimativa de 9:1000 nascimentos e taxas de prevalências para subtipos, aplicadas aos nascimentos de 2010. As estimativas de nascimentos com cardiopatia congênita foram comparadas com as notificações ao Ministério da Saúde. Foram estudados por métodos descritivos com uso de taxas e coeficientes, representados em tabelas.

          Resultados

          A incidência, no Brasil, é de 25.757 novos casos/ano, distribuídos em: Norte 2.758; Nordeste 7.570; Sudeste 10.112; Sul 3.329; e Centro-Oeste 1.987. Em 2010, foram notificados ao SINASC/MS 1.377 casos de nascidos com cardiopatias congênitas, o que representa 5,3% do estimado para Brasil. No mesmo período, os subtipos mais frequentes foram: comunicação interventricular (7.498); comunicação interatrial (4.693); persistência do canal arterial (2.490); estenose pulmonar (1.431); tetralogia de Fallot (973); coarctação da aorta (973); transposição das grandes artérias (887); e estenose aórtica 630. A prevalência de cardiopatias congênitas, para o ano de 2009, foi 675.495 crianças e adolescentes e 552.092 adultos.

          Conclusão

          Há, no Brasil, subnotificação na prevalência das cardiopatias congênitas, sinalizando para a necessidade de adequações na metodologia de seu registro.

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          Most cited references44

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          The incidence of congenital heart disease.

          This study was designed to determine the reasons for the variability of the incidence of congenital heart disease (CHD), estimate its true value and provide data about the incidence of specific major forms of CHD. The incidence of CHD in different studies varies from about 4/1,000 to 50/1,000 live births. The relative frequency of different major forms of CHD also differs greatly from study to study. In addition, another 20/1,000 live births have bicuspid aortic valves, isolated anomalous lobar pulmonary veins or a silent patent ductus arteriosus. The incidences reported in 62 studies published after 1955 were examined. Attention was paid to the ways in which the studies were conducted, with special reference to the increased use of echocardiography in the neonatal nursery. The total incidence of CHD was related to the relative frequency of ventricular septal defects (VSDs), the most common type of CHD. The incidences of individual major forms of CHD were determined from 44 studies. The incidence of CHD depends primarily on the number of small VSDs included in the series, and this number in turn depends upon how early the diagnosis is made. If major forms of CHD are stratified into trivial, moderate and severe categories, the variation in incidence depends mainly on the number of trivial lesions included. The incidence of moderate and severe forms of CHD is about 6/1,000 live births (19/1,000 live births if the potentially serious bicuspid aortic valve is included), and of all forms increases to 75/1,000 live births if tiny muscular VSDs present at birth and other trivial lesions are included. Given the causes of variation, there is no evidence for differences in incidence in different countries or times.
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            Congenital heart disease in the general population: changing prevalence and age distribution.

            Empirical data on the changing epidemiology of congenital heart disease (CHD) are scant. We determined the prevalence, age distribution, and proportion of adults and children with severe and other forms of CHD in the general population from 1985 to 2000. Where healthcare access is universal, we used administrative databases that systematically recorded all diagnoses and claims. Diagnostic codes conformed to the International Classification of Disease, ninth revision. Severe CHD was defined as tetralogy of Fallot, truncus arteriosus, transposition complexes, endocardial cushion defects, and univentricular heart. Prevalence of severe and other CHD lesions was determined in 1985, 1990, 1995, and 2000 using population numbers in Quebec. Children were subjects <18 years of age. The prevalence was 4.09 per 1000 adults in the year 2000 for all CHD and 0.38 per 1000 (9%) for those with severe lesions. Female subjects accounted for 57% of the adult CHD population. The median age of all patients with severe CHD was 11 years (interquartile range, 4 to 22 years) in 1985 and 17 years (interquartile range, 10 to 28 years) in 2000 (P<0.0001). The prevalence of severe CHD increased from 1985 to 2000, but the increase in adults was significantly higher than that observed in children. In the year 2000, 49% of those alive with severe CHD were adults. The prevalence in adults and median age of patients with severe CHD increased in the general population from 1985 to 2000. In 2000, there were nearly equal numbers of adults and children with severe CHD.
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              Task force 1: the changing profile of congenital heart disease in adult life.

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                Author and article information

                Journal
                Rev Bras Cir Cardiovasc
                Rev Bras Cir Cardiovasc
                Revista Brasileira de Cirurgia Cardiovascular : órgão oficial da Sociedade Brasileira de Cirurgia Cardiovascular
                Sociedade Brasileira de Cirurgia Cardiovascular
                0102-7638
                1678-9741
                Mar-Apr 2015
                Mar-Apr 2015
                : 30
                : 2
                : 219-224
                Affiliations
                [1 ] Specialist in Cardiovascular Surgery. Master’s Degree in Evaluation of Public Policies at Federal University of Ceará (UFC). Head of Pediatric Cardiovascular Surgery at Hospital Messejana and InCor Criança of Fortaleza, CE, Brazil. Head of the Pediatric Cardiovascular Surgery – Hospital Messejana).
                [2 ] University of São Paulo. Head of Pediatric Cardiology of the Hospital Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE, Brazil.
                [3 ] Medicine student at UniChristus, Fortaleza, CE, Brazil.
                [4 ] Specialist in cardiovascular surgery by BSCCV. Cardiovascular Surgeon at Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE, Brazil.
                [5 ] Epidemiologist Physician of Epidemiological Surveillance Cell of Fortaleza, Municipal Health Department, CE, Brazil. Master’s Degree in Public Health from Unicamp, Campinas, SP, Brazil.
                [6 ] Professor of Master’s Degree Course of Vocational Assessment of Public Policies by the UFC, Fortaleza, CE, Brazil.
                [7 ] Professor of Professional Master’s Degree Course in Public Policy Evaluation by the UFC, Fortaleza, CE, Brazil.
                [8 ] Nurse at the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE, Brazil.
                Author notes
                Correspondence address: Valdester Cavalcante Pinto Júnior, Rua Núbia Barrocas, 125, Parque Manibura Fortaleza - Ceará - Brazil, Zip code: 60821-775. E-mail: incorcrianca@ 123456yahoo.com.br
                Article
                10.5935/1678-9741.20150018
                4462968
                26107454
                286af185-6fd3-48e5-b29c-0d21861d7842

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 July 2013
                : 24 February 2015
                Categories
                Original Articles

                heart defects,congenital,epidemiology,health policy,brazil
                heart defects, congenital, epidemiology, health policy, brazil

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