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Age-Based Classification and Outcomes in Pediatric Heart Failure: Findings From a Retrospective Multicenter Cohort
Yuxing Yuan1, Bo Pan1, Fangjie Wang2
1Department of Cardiology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Key Laboratory of Children's Important Organ Development and Diseases of Chongqing Municipal Health Commission, National Clinical Key Cardiovascular Specialty Children's Hospital of Chongqing Medical University Chongqing China.
Insights
Pediatric heart failure (PHF) shows varied clinical traits and outcomes by age. Age-specific management is crucial for better treatment strategies in children with heart failure.
Area of Science:
- Pediatric Cardiology
- Clinical Research
- Public Health
Background:
- Heart failure in children (pediatric heart failure, PHF) is a significant global health issue with inadequately understood clinical characteristics.
- Existing knowledge gaps hinder the development of optimal treatment strategies for pediatric heart failure.
Purpose of the Study:
- To enhance the understanding of clinical characteristics across different pediatric heart failure age groups.
- To provide evidence-based references for improving pediatric heart failure treatment strategies through age-specific stratification.
Main Methods:
- A multicenter retrospective cohort study was conducted involving 2903 hospitalized pediatric heart failure patients (≤18 years) across 20 Chinese provinces.
- Patients were categorized into four age groups: neonatal, infant and toddler, young children, and adolescent.
- Data were collected between January 2013 and December 2022.
Main Results:
- Significant variations in clinical characteristics, auxiliary examinations, comorbidities, and hospitalization outcomes were observed among the four age groups.
- The odds of in-hospital death were lower in infant/toddler, young children, and adolescent groups compared to the neonatal group.
- Cardiovascular adverse events were more frequent in young children and adolescents, while adolescents had higher odds of a poor Ross class compared to other groups.
Conclusions:
- Age-specific stratification is essential for managing pediatric heart failure.
- Distinct clinical presentations and prognostic differences exist across pediatric heart failure developmental stages, necessitating tailored management approaches.
Background:
Although heart failure is a well-known major global public health concern, the general understanding of the clinical status of pediatric heart failure (PHF) is inadequate. Therefore, this study aims to enhance the general understanding of clinical characteristics across different PHF age groups and provide references for improving PHF treatment strategies.
Methods:
This multicenter retrospective cohort study involved patients from 20 Chinese provinces, primarily including hospitalized patients (aged ≤18 years) diagnosed with heart failure between January 2013 and December 2022. The study subjects were categorized into 4 groups: neonatal, infant and toddler, young children, and adolescent.
Results:
Herein, 2903 hospitalized patients with PHF were included. Significant differences were observed across age groups in clinical characteristics, auxiliary examination results, comorbid diagnoses, and hospitalization outcomes. After adjusting for covariates, the odds of in-hospital death were significantly lower in the infant and toddler (odds ratio [OR], 0.46 [95% CI, 0.25-0.85]), young children (OR, 0.39 [95% CI, 0.18-0.85]), and adolescent (OR, 0.34 [95% CI, 0.13-0.87]) groups compared with the neonatal group. Furthermore, the odds of cardiovascular adverse events were significantly higher in the young children (OR, 1.91 [95% CI, 1.62-2.88]) and adolescent (OR, 2.16 [95% CI, 1.15-4.06]) groups compared with the neonatal group. Additionally, regarding the odds of a bad Ross class, the adolescent group had 1.85 times higher odds (95% CI, 1.11-3.09) compared with the neonatal group, 2.36 times (95% CI, 1.67-3.35) higher odds compared with the infant and toddler group, and 1.45 times (95% CI, 1.05-2.02) higher odds compared with the young children group (P<0.05).
Conclusions:
This study emphasizes the importance of age-specific stratification in PHF management, revealing distinct clinical and prognostic differences across various developmental stages.
Registration:
URL: https://www.chictr.org.cn. Unique identifier: ChiCTR2300078262.
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