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Congenital heart disease screening reduced infant cardiac deaths in recent years
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The number of infant cardiac deaths decreased in states that implemented mandatory policies to screen newborns for congenital heart disease from 2007 to 2013, researchers reported in JAMA.
Rahi Abouk, PhD, assistant professor of economics, finance and global business at William Paterson University in Wayne, New Jersey, and colleagues analyzed data from the National Center for Health Statistics of 26,546,503 births in the U.S. from 2007 to June 2013.
Effect of screening policies examined
States were categorized as having a mandatory or nonmandatory screening policy for congenital heart disease. On June 1, 2013, five states had nonmandatory screening policies, eight states implemented mandatory policies and nine states had enacted policies that were not implemented yet.
The outcome of interest was the number of either early infant deaths, defined as 24 hours to less than 6 months, caused by congenital heart disease or other/unspecified congenital heart defects.
There were 2,734 deaths caused by critical congenital heart disease and 3,967 deaths from other/unspecified congenital heart causes from 2007 to 2013.
The death rates for patients with critical congenital heart disease in states that implemented mandatory screening policies decreased from deaths per 100,000 births (95% CI, 5.7-10.6) in 2007 to 6.4 deaths per 100,000 births (95% CI, 2.9-9.9) in 2013. Deaths related to other or unspecified cardiac causes were 11.7 deaths per 100,000 births (95% CI, 8.6-14.8) in 2007 and 10.3 deaths per 100,000 births (95% CI, 5.9-14.8) in 2013).
The mean adjusted relative decrease in deaths caused by critical congenital heart disease in states that implemented mandatory screening policies during the study period was 33.4% (95% CI, 10.6-50.3) and an absolute decrease of 3.9 deaths per 100,000 births (95% CI, 3.6-4.1). The number of deaths from other or unspecified cardiac causes decreased by 21.4% and an absolute decline of 3.5 deaths per 100,000 births (95% CI, 3.2-3.8)
States with nonmandatory screening policies did not have significant decreases in deaths.
“Retrospective evaluations of regulatory policies are important to validate the projected benefits of policies,” Abouk and colleagues wrote. “In addition, lessons learned from policy evaluations in one country can inform policy decisions in other countries. In particular, the findings have implications for countries that are considering possible adoption of a policy to routinely screen newborns for critical congenital heart disease.”
‘Successful public health intervention’
“The evidence is now sufficient to declare newborn screening for critical congenital heart disease a successful public health intervention,” Alex R. Kemper, MD, MPH, MS, division chief of ambulatory pediatrics at Nationwide Children’s Hospital in Columbus, Ohio; professor of pediatrics at The Ohio State University College of Medicine in Columbus; and member of the U.S. Preventive Services Task Force, and colleagues wrote in a related editorial. “Additional data are needed to provide more specific information about what aspects of the critical congenital heart disease newborn screening requirements are most effective in improving health outcomes.” – by Darlene Dobkowski
Disclosure: Abouk reports no relevant financial disclosures. Kemper reports he received funding from Masimo Corp. to participate in an international meeting on congenital heart disease.
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