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Cardiovascular outcomes in children with Kawasaki disease: a population-based cohort study
Cal Robinson1,2, Rahul Chanchlani3,4,5, Anastasia Gayowsky5
1Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
Insights
Children with Kawasaki disease (KD) face a higher risk of cardiovascular events after recovery, but a lower risk of death. Enhanced cardiac surveillance is recommended for KD survivors to manage long-term cardiovascular health.
Area of Science:
- Pediatric Cardiology
- Epidemiology
- Public Health
Background:
- Kawasaki disease (KD) is a critical pediatric illness with uncertain long-term cardiovascular event risks.
- Understanding post-illness cardiovascular outcomes is essential for patient management.
Purpose of the Study:
- To determine the incidence and risk of cardiovascular events and mortality in pediatric Kawasaki disease survivors.
- To compare cardiovascular outcomes in KD survivors versus a matched non-exposed cohort.
Main Methods:
- A population-based retrospective cohort study utilized Ontario health administrative databases.
- Pediatric KD hospitalizations (ages 0-18) from 1995-2018 were analyzed, with cases matched to 100 controls.
- Major adverse cardiac events (MACE) and composite cardiovascular events were primary and secondary outcomes, analyzed using multivariable Cox models.
Main Results:
- Among 4597 KD survivors, 1.7% experienced MACE and 13.8% had composite cardiovascular events over an 11-year median follow-up.
- KD survivors showed increased risks of MACE and composite cardiovascular events at various time points post-discharge.
- The incidence of ischemic heart disease and arrhythmias was notable in KD survivors; however, mortality risk was lower (aHR 0.36).
Conclusions:
- Kawasaki disease survivors face a heightened risk of post-discharge cardiovascular events.
- Despite increased cardiovascular event risk, KD survivors exhibit a lower mortality risk compared to non-exposed individuals.
- Enhanced cardiovascular surveillance and preventative counseling are crucial for managing long-term health in childhood KD survivors.
Background:
The risk of cardiovascular events after Kawasaki disease (KD) remains uncertain. Our objective was to determine the risk of cardiovascular events and mortality after KD.
Methods:
Population-based retrospective cohort study using Ontario health administrative databases (0-18 years; 1995-2018).
Exposure:
pediatric KD hospitalizations. Each case was matched to 100 non-exposed controls.
Primary Outcome:
major adverse cardiac events (MACE; cardiovascular death, myocardial infarction, or stroke composite).
Secondary Outcomes:
composite cardiovascular events and mortality. We determined incidence rates and adjusted hazard ratios (aHR) using multivariable Cox models.
Results:
Among 4597 KD survivors, 79 (1.7%) experienced MACE, 632 (13.8%) composite cardiovascular events, and 9 (0.2%) died during 11-year median follow-up. The most frequent cardiovascular events among KD survivors were ischemic heart disease (4.6 events/1000 person-years) and arrhythmias (4.5/1000 person-years). KD survivors were at increased risk of MACE between 0-1 and 5-10 years, and composite cardiovascular events at all time periods post-discharge. KD survivors had a lower mortality risk throughout follow-up (aHR 0.36, 95% CI 0.19-0.70).
Conclusion:
KD survivors are at increased risk of post-discharge cardiovascular events but have a lower risk of death, which justifies enhanced cardiovascular disease surveillance in these patients.
Impact:
Among 4597 Kawasaki disease (KD) survivors, 79 (1.7%) experienced major adverse cardiac events (MACE) and 632 (13.8%) had composite cardiovascular events during 11-year median follow-up. KD survivors had significantly higher risks of post-discharge MACE and cardiovascular events versus non-exposed children. Only nine KD survivors (0.2%) died during follow-up, and the risk of mortality was significantly lower among KD survivors versus non-exposed children. Childhood KD survivors should receive preventative counseling and cardiovascular surveillance, aiming to mitigate adult cardiovascular disease.
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