Original Investigation
Burden of Pediatric Heart Failure in the United States

https://doi.org/10.1016/j.jacc.2022.03.336Get rights and content
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Abstract

Background

There are currently limited accurate national estimates for pediatric heart failure (HF).

Objectives

This study aims to describe the current burden of primary and comorbid pediatric HF in the United States.

Methods

International Classification of Diseases, Clinical Modification codes were used to identify HF cases and comorbidities from the Kids’ Inpatient Database, National Inpatient Sample, National Emergency Department (ED) Sample, and National Vital Statistics System for 2012 and 2016. To describe HF events, all visits/events among pediatric and adult subjects were included in the analysis. HF events were classified into 1 of 3 groups: 1) no HF; 2) primary HF; or 3) comorbid HF. We compared patients with and without HF and calculated unique event rates with age and sex standardization.

Results

Congenital heart disease, conduction disorders/arrhythmias, and cardiomyopathy were responsible for the majority of pediatric HF-related ED visits and hospitalizations. Compared to 2012, in 2016, there was an increase in comorbid HF ED visits (rate ratio: 1.93; P < 0.001) and primary HF hospitalizations (rate ratio: 1.14; P = 0.002). Pediatric HF burden was lower compared to adult HF; however, deaths in the ED and in-hospital were significantly more likely in children presenting with HF than adults.

Conclusions

The burden of pediatric HF continues to increase. Compared to adults with HF presenting to the ED and in-hospital, outcomes are inferior and per patient resource use is higher for children hospitalized with HF. National initiatives to understand risk factors for morbidity and mortality in pediatric HF and continued surveillance and mitigation of preventable risk factors may attenuate this uptrend.

Key Words

deaths
emergency visits
heart failure
hospitalizations
national burden
pediatric

Abbreviations and Acronyms

ECMO
extracorporeal membrane oxygenation
ED
emergency department
HCUP
Healthcare Cost and Utilization Project
HF
heart failure
ICD-9/10-CM
International Classification of Diseases, 9th/10th version–Clinical Modification
KID
Kids’ Inpatient Database
NEDS
National Emergency Department Sample
NIS
National Inpatient Sample
NVSS
National Vital Statistics System
VAD
ventricular assist device

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