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Risk Factors for Heart Failure and Its Costs Among Children with Complex Congenital Heart Disease in a Medicaid
Deipanjan Nandi1, Joseph W Rossano2, Yinding Wang3
1The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Heart failure (HF) affects 7.6% of children with complex congenital heart diseases (CHDs). HF is linked to specific heart defects, genetic syndromes, and arrhythmias, leading to increased healthcare utilization and costs.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
Background:
- Heart failure (HF) is a significant concern in pediatric populations.
- Research on HF in children with complex congenital heart diseases (CHDs) remains limited.
- Understanding HF prevalence and associated factors in this group is crucial for effective management.
Purpose of the Study:
- To determine the prevalence of heart failure (HF) in children with complex congenital heart diseases (CHDs).
- To identify risk factors associated with HF development in this pediatric cohort.
- To analyze the healthcare costs and resource utilization linked to HF in complex CHD patients.
Main Methods:
- Analysis of the South Carolina Medicaid dataset from 1996-2010.
- Inclusion of 2999 pediatric patients (≤17 years) diagnosed with complex CHD.
- Statistical analysis to identify risk factors and cost implications of HF, controlling for comorbidities.
Main Results:
- Heart failure (HF) was diagnosed in 7.6% of the studied pediatric complex CHD cohort.
- Single ventricle lesions, genetic syndromes, and ventricular arrhythmias were significant risk factors for HF.
- Patients with HF incurred substantially higher healthcare costs, including increased subspecialty care, surgeries, hospitalizations, and emergency department visits.
Conclusions:
- Heart failure (HF) is a prevalent complication in children with complex congenital heart diseases (CHDs).
- Specific cardiac anomalies and genetic factors increase the risk of HF in this population.
- Management of HF in complex CHD necessitates intensive, multifaceted care, leading to significantly elevated healthcare expenditures.
Abstract:
Little research attention has been paid to the occurrence of heart failure (HF) in children with complex congenital heart diseases (CHDs). Herein, we describe the prevalence, risk factors, and costs associated with HF in complex CHD. Patients aged ≤17 years and diagnosed with a complex CHD on multiple service visits over a 15-year period in the SC Medicaid dataset (1996-2010) were tracked and analyzed. The cohort included 2999 unduplicated patients; 51.0% were male; 34.4% were African American. HF was diagnosed in 7.6%. Single ventricle lesions, genetic syndromes, and ventricular arrhythmia were significantly associated with an increased likelihood of being diagnosed with HF, controlling for development of comorbid pulmonary hypertension. Patients with HF received significantly more subspecialty care, more surgeries, more hospitalizations, more total days of inpatient care, and more emergency department care than those without HF. Patients with significantly higher total care costs paid by Medicaid had HF, more cardiac surgeries, and more specialized mechanical or other support procedures, controlling for diagnosed single ventricle CHD, a genetic syndrome, and number of non-cardiac surgeries. Complex CHD patients with HF incur significantly higher care costs but require multifaceted, intensive supports for management of incident complications and comorbid conditions.
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