CHD experts recommend exercise, risk factor control for older adults

Older adults with congenital heart disease (CHD) should be physically active and should control heart disease risk factors such as obesity, diabetes, high blood pressure and smoking, according to an American Heart Association (AHA) scientific statement released on April 20.

Lead researcher Ami B. Bhatt, MD, of Massachusetts General Hospital, and colleagues recommended that adults with CHD be followed by a cardiologist and share records with their primary care physicians about their disease history, diagnoses and surgeries.

The researchers said adults with CHD should be treated in a specialized center and should undergo cardiopulmonary exercise testing to assess for arrhythmias and ischemia. They added that stress echocardiography can be used to assess worsening valvular disease or pulmonary hypertension.

Approximately 80 percent of adults with CHD have at least one cardiovascular risk factor such as hypertension, hyperlipidemia and diabetes. Thus, Bhatt et al suggested providers focus on primary prevention and risk factor management in this patient population.

The statement applies to structural CHD, including coronary artery anomalies and aortopathy associated with bicuspid aortic valve disease. It excludes familial cardiomyopathies, degenerative mitral valve disease, genetically based arrhythmias, connective tissue disease and familial aortic aneurysm.

Previous research found 98 percent of patients with mild CHD, 96 percent of patients with moderate CHD and 56 percent of patients with severe forms of CHD survive until adulthood. In addition, there is a sharp increase in mortality after 65 years of age, while approximately 80 percent of deaths in adults with CHD are due to heart failure, sudden death, arrhythmias and vascular complications.

Although there are now more cardiac surgery and noncardiac surgical interventional options, the researchers noted there are few large clinical trials that have examined CHD in older adults. They said further studies should examine screening for and treatment of traditional risk factors for coronary artery disease, development of heart failure and progression of valvular disease.

The statement is available online in Circulation.