Incidence of Stroke in Adults With Congenital Heart Disease

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.