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Epidemiology of Pediatric Heart Failure in the USA-a 15-Year Multi-Institutional Study

Raysa Morales-Demori1, Elena Montañes2, Gwen Erkonen3

  • 1Department of Pediatrics, Division of Critical Care, Baylor College of Medicine, Texas Children's Hospital, 6651 Main St. MC E1420, Houston, TX, USA. demori@bcm.edu.

Pediatric Cardiology
|April 19, 2021
PubMed

Insights

Pediatric heart failure (HF) admissions increased, with higher mortality in patients with congenital heart disease plus cardiomyopathy (CHD+CM). Interventions like extracorporeal circulatory support (ECLS) and heart transplantation (HTX) expanded but outcomes varied by group.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Research
  • Epidemiology of Heart Failure

Background:

  • Pediatric heart failure (HF) epidemiology is established for congenital heart disease (CHD) and cardiomyopathies (CM) separately.
  • The impact of co-occurring CM in pediatric patients with CHD remains understudied.
  • Understanding these distinct and overlapping populations is crucial for improving care.

Purpose of the Study:

  • To characterize the demographics and clinical outcomes of pediatric inpatient HF patients.
  • To compare outcomes among patients with CHD, CM, and CHD with CM (CHD+CM).
  • To analyze trends in HF admissions, interventions, and mortality in the US.

Main Methods:

  • Retrospective analysis of 67,349 pediatric HF patients (≤19 years) from the Pediatric Health Information System database (2004-2019).
  • Inclusion criteria: HF patients with CM diagnoses, with or without CHD, identified via ICD 9/10 codes.
  • Data analysis included trends in admissions, extracorporeal circulatory support (ECLS), heart transplantation (HTX), inpatient mortality, and hospital charges.

Main Results:

  • Pediatric HF admissions and ECLS use significantly increased from 2004-2018.
  • Heart transplantation (HTX) increased in CHD and CHD+CM groups; CHD patients had higher mortality post-procedure.
  • Cardiomyopathy (CM) patients had lower post-HTX mortality. CHD+CM patients exhibited the highest inpatient mortality (15%) and hospital charges.

Conclusions:

  • Pediatric HF admissions are rising, with increased use of ECLS and HTX.
  • While interventions improved outcomes in CHD and CM groups, CHD+CM patients face the highest inpatient mortality.
  • CHD+CM represents a growing, high-risk population requiring targeted management strategies.

Keywords:
CardiomyopathyCongenital Heart DiseaseEpidemiologyHeart failureOutcomesPediatrics

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