The burden of pediatric heart failure (HF) is rising in the U.S., largely due to increases in emergency department (ED) visits and hospitalizations, according to findings from a new study published in the Journal of the American College of Cardiology. While the burden of pediatric HF is still lower across the health care system than that of adults with HF, the per patient resource use and rates of ED- and in-hospital mortality are significantly higher in this patient population, researchers said.

Shahnawaz Amdani, MD, FACC, et al., identified HF cases and comorbidities from the Kids’ Inpatient Database, National Inpatient Sample, National ED Sample and National Vital Statistics System for 2012 and 2016. Patients were classified in three groups: 1) No HF; 2) primary HF; or 3) comorbid HF.

Overall results showed 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) in 2016 compared with 2012. Congenital heart disease, conduction disorder/arrhythmias and cardiomyopathy were responsible for most of the pediatric HF-related ED visits and hospitalizations. Children with HF had nearly double the number of ED visits compared with those with no HF (2,373 vs. 1,1813) and nearly 24-fold more hospitalizations (141,328 vs. 5,852).

In other observations, children hospitalized with HF were significantly more likely to require advanced therapies: extracorporeal membrane oxygenation (3.9% vs. 0.07%), ventricular assist devices (1.7% vs. 0.53%), and heart transplantation (5.3% vs. 0.97%) (p<0.001 for all). They also had longer hospital stays (median, 7.5 days vs. 3.8 days; p<0.001) and had higher per patient charges (median $141,328 vs. $36,116; p<0.001). Researchers found no sex or racial/ethnic differences among children with HF in terms of U.S. hospitalizations.

The authors note that as HF rates in children continue to increase, it is like that hospitalization costs and resources for those children will also continue to increase. “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,” they said.

In an accompanying editorial comment, Kevin P. Daly, MD, et al., write: “The data provided by Amdani et al., clearly demonstrate that pediatric HF is a morbid disease, approaching and exceeding mortality seen with many common pediatric cancers.” They underscore that these challenges specific to pediatric patients with HF will challenge practitioners to become strategically creative and identify opportunities for additional research. This study “highlight[s] just how much pediatric HF is bubbling beneath the surface,” they write, “and it is incumbent on the pediatric HF community to develop innovative solutions to improve the care of these patients and to prevent HF from breaking through.”

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Interventions, CHD and Pediatrics and Quality Improvement, Acute Heart Failure, Heart Transplant, Mechanical Circulatory Support, Interventions and Structural Heart Disease

Keywords: Morbidity, Cardiology, Arrhythmias, Cardiac, Delivery of Health Care, Heart Transplantation, Heart Defects, Congenital, Neoplasms, Risk Factors, Emergency Service, Hospital, Cardiomyopathies, Heart Failure, Hospitalization, Heart-Assist Devices, Extracorporeal Membrane Oxygenation, Inpatients, Length of Stay, Hospital Mortality

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