Abstract 13263: Risk of Heart Failure in Children and Young Adults Born Preterm- A National Cohort Study

Introduction: An increasing number of infants survive preterm birth. Previous studies have found that preterm birth is associated with increased risks of hypertension, stroke and cardiovascular mortality later in life. We hypothesized that preterm birth would be associated with an increased risk of later heart failure. Aim: To investigate the association between preterm birth and incident heart failure children and young adults without previous ischemic heart disease. Material and Methods: This registry-based cohort included 2.5 million individuals born in Sweden between 1987 and 2010. Subjects were followed from one year of age to end of study in December 2011. Event definition was a diagnosis of or death from heart failure in the Swedish National Patient Register or Cause of Death Register. We used Cox proportional hazards regression to estimate the association between preterm birth (categorized as extremely preterm, <28 weeks of gestation; very preterm, <28-31 weeks of gestation; and moderately preterm, 32-36 weeks of gestation) and heart failure. Results: During 29.2 million years of follow-up time we found 373 cases of heart failure (1.3/100 000 person-years). Preterm birth was associated with an increased risk of heart failure across all categories of prematurity, also after exclusion of children with major malformations and adjustment for birth weight, maternal and paternal cardiovascular disease, and other potential confounders. Risk elevation was most pronounced in subjects born <28 weeks, with an adjusted hazard ratio of 19.5 (95% CI, 7.89-48.23). Corresponding hazard ratios for very and moderately preterm birth were 3.11 (1.12-8.62) and 1.76 (1.10-2.81), compared to subjects born at term. Conclusions: This study found a strong association between preterm birth and risk of incident heart failure in children and young adults. Risk elevation was inversely related to gestational age at birth. Although the absolute risk of heart failure is low at this young age, our findings may indicate a future health problem among the new generations of survivors after preterm birth.