Medical Director, Advanced Cardiac Therapies Program Children's National Hospital, Washington DC Bethesda, Maryland, United States
Abstract:
Background: Admissions for pediatric heart failure (pHF) are increasing. This is true for pHF related both to congenital heart disease as well as non-congenital heart disease related heart failure. Studies have shown that presence of renal dysfunction (RD) and neurologic complications (NC) are determinants of outcomes for interventions such as cardiac surgery, heart transplantation and circulatory support. However, the overall burden of these morbidities in pHF patients necessitating hospitalization is not well described. We therefore used the Pediatric Health Information System (PHIS) database to assess the overall burden of renal and neurologic complications as well as assess the impact of the same on pHF hospitalizations.
Methods: Retrospective analysis of the PHIS database from 2004-2020 for all hospital discharges with primary diagnosis of heart failure using ICD 9/10 codes. We excluded patients with congenital heart disease and repeat admissions. Renal and neurologic dysfunction was also diagnosed using ICD9/10 codes or using detailing billing data by an experienced analyst. Appropriate statistical analysis was performed.
Results: A total of 17227 hospitalizations for pHF occurred during the time frame of which 5515 patients were included in the analysis after excluding CHD (7265), repeat admission (3868), or lack of billing data(579). RD was noted in 1239 (22.5%). Black race was a significantly associated with the development of RD. Those with RD were more likely to be in ICU, significantly more likely to need mechanical ventilation, ECMO support, TPN, dialysis, VAD placement, heart transplantation and kidney transplantation (all p< 0.001). Discharge mortality was 3x higher for those with renal dysfunction in pHF compared to those who did not. Neurologic complications (NC) were diagnosed in 539 (9.8%) of the pHF patients. These were significantly more common in females but race did not have an impact. Those with NC were significantly more likely to be in ICU, need mechanical ventilation, ECMO support, TPN, dialysis, VAD placement, and undergo heart transplantation (21%vs7.8%), all p< 0.001. Discharge mortality for those with NC was 18.4% compared to 4.6% (p < 0.001) for those without ND.
Conclusion: In this analysis, we noted that renal and neurologic complications occur in a significant portion of pHF patients. Patients with renal and neurologic complications are significantly more likely to have higher complexity, acuity and 3x to 4x times mortality. Better understanding of these morbidities and of management strategies on reducing the impact will be critical in improving overall outcomes of pHF hospitalizations.
