Risk markers for excess mortality in adults with congenital heart disease: does one size fit all?

Over the past few decades, improved survival in patients with congenital heart disease (CHD), particularly those with severe defects, has given rise to a rapidly growing and aging population of adult survivors with increasingly complex disease (1,2). Nevertheless, mortality rates remain higher than the general population, with patients most commonly succumbing to heart failure and to sudden death of presumed arrhythmic etiology. In a recent issue of the European Heart Journal, Oliver et al. explored factors associated with excess mortality in a cohort of 3,311 adults with CHD followed for a median of 10.5 years in a dedicated referral center (3).