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Giorni C, Cantarutti N, Olimpieri A, Benegni S, Rizza A, Favia I, Felice GD, Vallesi L, Brancaccio G, Amodeo A, Chiara LD, Ricci Z. Heparin Versus Bivalirudin in Pediatric Patients Assisted With Mechanical Circulatory Support: A Retrospective Before-and-after Study. J Cardiothorac Vasc Anesth 2025; 39:1242-1249. [PMID: 40021444 DOI: 10.1053/j.jvca.2025.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Revised: 01/27/2025] [Accepted: 01/29/2025] [Indexed: 03/03/2025]
Abstract
OBJECTIVES Children assisted with mechanical circulatory support experience bleeding and thrombotic complications that may depend upon anticoagulation strategies. The primary aim of this study was to compare the incidence of thrombotic events in pediatric heart failure patients assisted with mechanical circulatory support with the use of bivalirudin versus heparin anticoagulation. A secondary aim was to compare the percentage of out-of-range partial thromboplastin time values between these anticoagulants. DESIGN Retrospective cohort study. SETTING Tertiary pediatric cardiac intensive care unit. PARTICIPANTS Pediatric patients undergoing mechanical circulatory support for cardiac failure. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 36 pediatric patients on mechanical support treated with either heparin (n.18) or bivalirudin (n.18) during the first 30 days of intensive care unit admission were compared. Bivalirudin group data were retrieved from February 2018 to August 2020 while data on the heparin group were extrapolated from 2015 to 2017. A comparison of anticoagulation was conducted specifically in EXCOR Berlin Heart and extracorporeal membrane oxygenation patients. Berlin Heart patients showed 1 (12.5%) versus 8 (80%) thrombotic episodes in the bivalirudin and heparin groups, respectively (p = 0.005), 0 and 3 (30%) cerebrovascular events, and 0 versus 3 (30%) death episodes, respectively (p = 0.054). In extracorporeal membrane oxygenation patients, the bivalirudin and heparin groups showed 0 versus 1 (8.3%) patient with a thrombosis episode (p = 0.40), 0 and 0 cerebrovascular events, and 5 (50%) versus 3 (25%) death episodes, respectively (p = 0.169). The number of out-of-range partial thromboplastin time values was higher in the heparin group both in Berlin Heart and extracorporeal membrane oxygenation patients (p < 0.0001). CONCLUSIONS In a cohort of children with heart failure, bivalirudin use was associated with a reduction in thrombotic events in Berlin Heart patients compared with heparin over a period of 30 days.
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Affiliation(s)
- Chiara Giorni
- Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Nicoletta Cantarutti
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandro Olimpieri
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome, Italy
| | - Simona Benegni
- Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandra Rizza
- Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Isabella Favia
- Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovina Di Felice
- Hemostasis Laboratory, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Gianluca Brancaccio
- Pediatric Cardiac Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Amodeo
- Heart Failure, Transplantation, Cardiorespiratory Mechanical Assistance Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luca Di Chiara
- Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Zaccaria Ricci
- Pediatric Intensive Care Unit, Meyer Children's Hospital, IRCCS, Florence, Italy; Department of Health Sciences, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy
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May LJ, Stehlik J, Wilkes J, Ou Z, Pinto NM, Cabrera AG, Tristani-Firouzi M, Keenan HT. Case Ascertainment in Pediatric Heart Failure Using International Classification of Disease Clinical Modification (ICD-CM) Codes. Pediatr Cardiol 2024:10.1007/s00246-024-03698-0. [PMID: 39547975 DOI: 10.1007/s00246-024-03698-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 10/23/2024] [Indexed: 11/17/2024]
Abstract
Most epidemiological studies in pediatric heart failure (HF) use administrative database sources, defining patient cohorts by presence of a single HF ICD code. However, the ability of ICD codes to identify true HF patients is unknown in pediatrics. Here we describe the accuracy of HF ICD-10-CM code search algorithms, in identifying pediatric patients with HF from electronic data sources. Based on the adult HF literature, search algorithms were designed to incorporate HF ICD codes, imaging, and medications. Sensitivity, specificity, positive and negative predictive value and accuracy of the algorithms were tested among children in an advanced HF clinic ("Clinic cohort"). Top-performing algorithms were then tested in a large-scale regional electronic data warehouse (EDW), 01/2017 to 01/2020, generating the "EDW Cohort". False positive cases were identified and characterized by chart review. Within the Clinic Cohort, 78/378 patients (21%) had gold standard HF diagnoses. A search algorithm with one HF ICD coded visit was more sensitive but less specific than > 1 HF ICD coded visit, (sensitivity 94% and specificity 89% versus 69% and 97%, respectively). Correspondingly, > 1 ICD coded visit had a higher PPV than one ICD coded visit; 84% vs. 69%. Accuracy was similar (90% vs 91%). Presence of 1 HF ICD code combined with HF medication had high sensitivity, specificity, PPV, NPV and accuracy, all higher than the single ICD code algorithm. The "1 HF coded visit + any medication" algorithm resulted in highest accuracy (93%). Top-performing algorithms were tested in the EDW: the algorithm with > 1 HF ICD coded visit, and the algorithm with one HF ICD coded visit combined with HF medication. In the EDW Cohort, 133/248 (53.6%) patients had gold standard HF diagnoses though 115/248 (46.3%) were false positive cases; 41% of those had pulmonary over-circulation from congenital heart disease. Excluding children < 30 days old and those with a history of an isolated VSD repair, complete AVSD repair, or PDA closure further reduced the proportion of false positives to 50/248 (20%). A search algorithm using a single HF ICD code can have acceptable sensitivity, specificity, PPV, NPV and accuracy in identifying children with HF from within electronic medical records. Similar to adult HF literature, specificity improves by including HF medication. When applied to large data sources, however, the search algorithms result in a high proportion of patients with pulmonary overcirculation related to congenital heart disease. To narrow the population to those with myocardial dysfunction, case identification may require use of ICD codes with linked of administrative, surgical, and/or imaging databases.
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Affiliation(s)
- Lindsay J May
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Nelangi M Pinto
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Antonio G Cabrera
- Department of Pediatrics, Ohio State Unviersity College of Medicine, Columbus, OH, USA
| | | | - Heather T Keenan
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
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May LJ, Stehlik J, Wilkes J, Ou Z, Pinto NM, Cabrera AG, Tristani-Firouzi M, Keenan HT. Case Ascertainment in Pediatric Heart Failure Using International Classification of Disease Clinical Modification (ICD-CM) Codes. RESEARCH SQUARE 2024:rs.3.rs-4941771. [PMID: 39483912 PMCID: PMC11527347 DOI: 10.21203/rs.3.rs-4941771/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2024]
Abstract
Background Most epidemiological studies in pediatric heart failure (HF) use administrative database sources, defining patient cohorts by presence of a single HF ICD code. However, the ability of ICD codes to identify true HF patients is unknown in pediatrics. Here we describe the accuracy of HF ICD-10-CM code search algorithms, in identifying pediatric patients with HF from electronic data sources. Methods Based on the adult HF literature, search algorithms were designed to incorporate HF ICD codes, imaging, and medications. Sensitivity, specificity, positive and negative predictive value and accuracy of the algorithms were tested among children in an advanced HF clinic ("Clinic cohort"). Top-performing algorithms were then tested in a large-scale regional electronic data warehouse (EDW), 01/2017 to 01/2020, generating the "EDW Cohort". False positive cases were identified and characterized by chart review. Results Within the Clinic Cohort, 78/378 patients (21%) had gold standard HF diagnoses. A search algorithm with one HF ICD coded visit was more sensitive but less specific than >1 HF ICD coded visit, (sensitivity 94% and specificity 89% versus 69% and 97%, respectively). Correspondingly, >1 ICD coded visit had a higher PPV than one ICD coded visit; 84% vs. 69%. Accuracy was similar (90% vs 91%). Presence of 1 HF ICD code combined with HF medication had high sensitivity, specificity, PPV, NPV and accuracy, all higher than the single ICD code algorithm. The "1 HF coded visit + any medication" algorithm resulted in highest accuracy (93%). Top-performing algorithms were tested in the EDW: the algorithm with > 1 HF ICD coded visit, and the algorithm with one HF ICD coded visit combined with HF medication. In the EDW Cohort, 133/248 (53.6%) patients had gold standard HF diagnoses though 115/248 (46.3%) were false positive cases; 41% of those had pulmonary over-circulation from congenital heart disease. Excluding children < 30 days old and those with a history of an isolated VSD repair, complete AVSD repair, or PDA closure further reduced the proportion of false positives to 50/248 (20%). Conclusions A search algorithm using a single HF ICD code can have acceptable sensitivity, specificity, PPV, NPV and accuracy in identifying children with HF from within electronic medical records. Similar to adult HF literature, specificity improves by including HF medication. When applied to large data sources, however, the search algorithms result in a high proportion of patients with pulmonary overcirculation related to congenital heart disease. To narrow the population to those with myocardial dysfunction, case identification may require use of ICD codes with linked of administrative, surgical, and/or imaging databases.
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Kamsheh AM, Bilker WB, Huang YS, Okunowo O, Burstein DS, Edelson JB, Lin KY, Maeda K, Mavroudis CD, O'Connor MJ, Wittlieb-Weber CA, Bogner HR, Rossano JW. Prolonged Inotrope Use After Surgery for Congenital Heart Disease: A Common Occurrence with a High Burden of Mortality. Pediatr Cardiol 2024:10.1007/s00246-024-03619-1. [PMID: 39141125 PMCID: PMC11825883 DOI: 10.1007/s00246-024-03619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/05/2024] [Indexed: 08/15/2024]
Abstract
Outcomes in patients requiring prolonged inotropes (PI) following surgery for congenital heart disease (CHD) have not been well studied. We aimed to describe the burden of PI use in the immediate postoperative period after CHD surgery and identify risk factors for in-hospital mortality. We conducted a retrospective cohort study using the Pediatric Health Information System® (PHIS) database. Patients 0-18 years with CHD who underwent cardiovascular surgery from 2010 to 2020 were included. Patients who received inotropic medications for > 7 consecutive days after surgery were in the PI group and all others in the control group. Patients who died before 7 days were excluded. Multivariable mixed-effect logistic regression was used to examine risk factors for in-hospital mortality. There were 110,271 patients from 48 centers included, 10,292 in the PI group and 99,979 in the control group. In-hospital mortality was significantly higher in the PI group (24.9% vs. 4.6%, p < 0.001). Ventricular assist device use was rare (1.6%). After adjustment, odds of in-hospital mortality in the PI group was 3.5 (95% CI 3.3-3.8) times higher than in controls. Independent risk factors for in-hospital mortality were age, non-White race, class of CHD, number of complex chronic conditions, preoperative inotrope, preoperative extracorporeal membrane oxygenation, sepsis, stroke, renal failure, number of inotropes at 7 days, and discharge year (p < 0.01 for all). Postoperative PI use in CHD is common and carries a considerable burden of mortality. Additional work is needed to understand which risk factors are modifiable and which patients may benefit from reintervention or advanced heart failure therapies.
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Affiliation(s)
- Alicia M Kamsheh
- Division of Pediatric Cardiology, Washington University School of Medicine, Northwest Tower Room 8218, 4990 Children's Place, St. Louis, MO, 63110, USA.
| | - Warren B Bilker
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Yuan-Shung Huang
- Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Oluwatimilehin Okunowo
- Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Danielle S Burstein
- Division of Pediatric Cardiology, Department of Pediatrics, The University of Vermont, Burlington, VT, USA
| | - Jonathan B Edelson
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kimberly Y Lin
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Katsuhide Maeda
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Constantine D Mavroudis
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew J O'Connor
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Hillary R Bogner
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph W Rossano
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Conway J, Barrett O, Pidborochynski T, Schroeder K, Cunningham C, Jeewa A, Kaul P. Administrative Databases: Friend or Foe in Paediatric Cardiomyopathy. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:490-493. [PMID: 38205436 PMCID: PMC10777199 DOI: 10.1016/j.cjcpc.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 01/12/2024]
Abstract
Background Cardiomyopathy (CM) is a rare childhood disease associated with morbidity and mortality. Limited data exist on paediatric CM in Canada. Given the rare nature, single-centre studies are not sufficiently powered to address important questions. Therefore, administrative health data may serve as a resource for the study of childhood CM. The goal of this study was to validate the accuracy of International Classification of Diseases (ICD)-based algorithms to identify paediatric CM in health databases using a clinical registry as the gold standard. Methods The clinical registry was compiled from outpatient and inpatient records at the Stollery Children's Hospital (January 1, 2013, to December 31, 2021). Patients were categorized as having CM or screened without CM. Data were linked to administrative health databases using the patient's Unique Lifetime Identifier. Algorithms based on the presence of ICD, 10th Revision, codes for CM were then evaluated, and cross-tabulations against the clinical registry were generated. Accuracy, positive predictive value, negative predictive value, sensitivity, and specificity were calculated. Results The clinical registry had 90 patients with CM and 249 screened without CM. The algorithms ruled out CM (high negative predictive value) but had variability in the ability to diagnose CM positive predictive value. The algorithm that performed the best was based on a diagnosis of CM in a hospitalization or 2 ambulatory visits. Conclusions A combination of inpatient and outpatient databases can be used, with acceptable accuracy, to identify paediatric patients with CM. This finding allows for the use of the identified algorithm for the comprehensive study of paediatric CM in Canada.
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Affiliation(s)
- Jennifer Conway
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Katie Schroeder
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Chentel Cunningham
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Aamir Jeewa
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Padma Kaul
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Das B, Godown J, Deshpande SR. Burden of Renal Dysfunction and Neurologic Complications in Hospitalized Pediatric Heart Failure Unrelated to Congenital Heart Disease: A Multicenter Study. TRANSPLANTOLOGY 2023; 4:209-217. [DOI: 10.3390/transplantology4040020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2025] Open
Abstract
Objectives: Limited data are available on renal dysfunction and neurologic complications in heart failure in children, when the heart failure is not related to congenital heart disease (CHD) or cardiac surgery. This study used a multi-center database to describe pediatric heart failure (pHF)-related renal dysfunction, neurological complications, and outcomes in non-CHD patients. Methods: The Pediatric Health Information System (PHIS) database between 2004 and 2020 was used to analyze the prevalence of renal dysfunction and neurologic complications associated with pHF hospitalizations and their impact on outcomes. Results: Of the 5515 hospitalizations included in the study, renal dysfunction was identified in 1239 (22.5%), and neurologic dysfunction was diagnosed in 539 (9.8%). The diagnosis of renal or neurologic complications was associated with significantly higher use of ICU therapies, including mechanical ventilation, parenteral nutrition, and mechanical circulatory support. Patients with significant renal dysfunction were likely to receive kidney transplants in 3.1% of the cases. Neurologic complications were higher in patients with pHF who underwent heart transplantation (21.3% vs. 7.8%, p < 0.001). Patients with renal dysfunction and neurologic complications had significantly higher mortality rates than those without renal dysfunction (11.7% vs. 4.3%, p < 0.001) and neurologic complications (18.4% vs. 4.6%, p < 0.001). Conclusions: Renal dysfunction and neurologic complications are common, resulting in significantly higher utilization of ICU therapies and mortality rates during non-CHD-related pHF hospitalization. Neurologic complications associated with hospitalization for pHF are associated with a significantly higher mortality, which has been underemphasized in the literature. This study assesses the burden of these morbidities and highlights the importance of monitoring and managing renal and neurologic complications in pHF to improve outcomes.
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Affiliation(s)
- Bibhuti Das
- Division of Pediatric Cardiology, Department of Pediatrics, McLane Children’s Baylor Scott and White Medical Center, Baylor College of Medicine-Temple, Temple, TX 76504, USA
| | - Justin Godown
- Division of Pediatric Cardiology, Monroe Carrel Jr Children’s Hospital, Vanderbilt University, Nashville, TN 37235, USA
| | - Shriprasad R. Deshpande
- Heart Transplant and Advanced Cardiac Therapies Program, Division of Pediatric Cardiology, Children’s National Hospital, George Washington University, 111, Michigan Ave NW, Washington, DC 20010, USA
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Restaino K, Zhang X, Faerber JA, Rossano JW, Burstein D, Wittlieb-Weber CA, Lin KY, Edelson JB, Edwards JJ, O’Connor MJ. Temporal trends in primary payers in pediatric heart transplant and association with long-term survival. Pediatr Transplant 2023; 27:e14484. [PMID: 36751006 PMCID: PMC10290494 DOI: 10.1111/petr.14484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Pediatric heart transplantation (HT) is resource intensive. In adults, there has been an increase in the proportion of HTs funded by public insurance, with post-HT outcomes inferior to those funded by private sources. Trends in the funding of pediatric HT and outcomes in children have not been described. METHODS We queried the United Network for Organ Sharing (UNOS) database for children (<18 years) listed for and undergoing HT between 2004 and 2021. We identified the primary payer at listing, HT, 1 year, and 1-5 years following HT. Trends were analyzed using generalized logit models. Multivariable-extended Cox regression models were used to test the relationship between insurance type at the time of transplant and time to death or re-transplant. RESULTS There were 6382 pediatric patients who underwent transplants and had either public or private insurance at the time of transplant. The percentage of patients with public insurance at the time of HT increased over time. Public insurance at the time of HT was associated with an increased risk of death or re-transplant beyond 2 months after HT (adjusted HR at 6 months = 1.43, 95% CI: 1.13-1.81, p = .003; adjusted HR at 9 months = 1.67, 95% CI: 1.17-2.37, p = .004). CONCLUSION There has been a statistically significant trend toward increasing public insurance for children awaiting, at the time of, and after HT. Black patients and those with public insurance at HT have worse long-term outcomes. This study highlights ongoing disparities in pediatric HT and the need to focus efforts on achieving equitable outcomes.
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Affiliation(s)
- Kathryn Restaino
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Xuemei Zhang
- Data Science and Biostatistics Team, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jennifer A. Faerber
- Data Science and Biostatistics Team, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joseph W. Rossano
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Danielle Burstein
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Kimberly Y. Lin
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jonathan B. Edelson
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jonathan J. Edwards
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew J. O’Connor
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Abstract
Heart failure is a highly morbid syndrome, recognized as a major cause of adult mortality. Heart failure in pediatric patients, whether in the setting of congenital or acquired heart disease, is similarly associated with high mortality and resource utilization. Understanding the clinical presentation, diagnosis, and initial stabilization of pediatric heart failure is paramount for any acute care clinician as it may mimic common childhood ailments like viral respiratory or gastrointestinal illnesses. Pediatric heart failure occurs in patients with palliated or unpalliated congenital heart disease, familial or acquired cardiomyopathy, acquired valve disease, and myocarditis. This review will focus on heart failure in pediatric patients with structurally normal hearts and will summarize what is known about patterns of presentation, etiologies, diagnostic evaluation, and the acute and chronic management of this highly morbid syndrome.
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Pradhan SK, Adnani H, Safadi R, Yerigeri K, Nayak S, Raina R, Sinha R. Cardiorenal syndrome in the pediatric population: A systematic review. Ann Pediatr Cardiol 2022; 15:493-510. [PMID: 37152514 PMCID: PMC10158476 DOI: 10.4103/apc.apc_50_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/26/2022] [Accepted: 08/17/2022] [Indexed: 03/03/2023] Open
Abstract
The concept of cardiorenal syndrome (CRS) is derived from the crosstalk between the heart and kidneys in pathological conditions. Despite the rising importance of CRS, there is a paucity of information on the understanding of its pathophysiology and management, increasing both morbidity and mortality for patients. This review summarizes the existing conceptual pathophysiology of different types of CRS and delves into the associated therapeutic modalities with a focus on pediatric cases. Prospective or retrospective observational studies, comparative studies, case reports, case-control, and cross-sectional studies that include pediatric patients with CRS were included in this review. Literature was searched using PubMed, EMBASE, and Google Scholar with keywords including "cardio-renal syndrome, type," "reno-cardio syndrome," "children," "acute kidney injury," and "acute decompensated heart failure" from January 2000 to January 2021. A total of 14 pediatric studies were ultimately included and analyzed, comprising a combined population of 3608 children of which 32% had CRS. Of the 14 studies, 57% were based on type 1 CRS, 14% on types 2 and 3 CRS, and 7% were on types 4 and 5 CRS. The majority of included studies were prospective cohort, although a wide spectrum was observed in terms of patient age, comorbidities, etiologies, and treatment strategies. Commonly observed comorbidities in CRS type 1 were hematologic, oncologic, cardiology-related side effects, muscular dystrophy, and pneumonia/bronchiolitis. CRS, particularly type 1, is prevalent in children and has a significant risk of mortality. The current treatment regimen primarily involves diuretics, extracorporeal fluid removal, and treatment of underlying etiologies and comorbidities.
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Affiliation(s)
- Subal Kumar Pradhan
- Division of Pediatric Nephrology, Sardar Vallabhbhai Patel Post Graduate Institute of Pediatrics and SCB Medical College, Cuttack, Odisha, India
| | - Harsha Adnani
- Anne Arundel Medical Center, Luminis Health System, Annapolis, Maryland, USA
| | - Rama Safadi
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio, USA
| | - Keval Yerigeri
- Department of Nephrology, Akron, Ohio, USA, Children’s Hospital, Akron, Ohio, USA
| | - Snehamayee Nayak
- Department of Pediatrics, Sardar Vallabhbhai Patel Post Graduate Institute of Pediatrics and SCB Medical College, Cuttack, Odisha, India
| | - Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, Ohio, USA
- Department of Nephrology, Akron, Ohio, USA, Children’s Hospital, Akron, Ohio, USA
| | - Rajiv Sinha
- Division of Pediatric Nephrology, Institute of Child Health, Kolkata, West Bengal, India
- Department of Pediatrics, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
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Amdani S, Marino BS, Rossano J, Lopez R, Schold JD, Tang WHW. Burden of Pediatric Heart Failure in the United States. J Am Coll Cardiol 2022; 79:1917-1928. [PMID: 35550689 DOI: 10.1016/j.jacc.2022.03.336] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/18/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
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.
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Affiliation(s)
- Shahnawaz Amdani
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio, USA.
| | - Bradley S Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Joseph Rossano
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rocio Lopez
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jesse D Schold
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Horsley M, Pathak S, Morales D, Lorts A, Mouzaki M. Nutritional Outcomes of Patients with Pediatric and Congenital Heart Disease Requiring Ventricular Assist Device. JPEN J Parenter Enteral Nutr 2022; 46:1553-1558. [DOI: 10.1002/jpen.2351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/20/2022] [Accepted: 02/14/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - David Morales
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery
- Division of Cardiology
| | - Angela Lorts
- Department of Clinical Pediatrics
- Division of Cardiology
| | - Marialena Mouzaki
- Department of Clinical Pediatrics
- Division of Gastroenterology, Hepatology and Nutrition Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine
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12
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Morales-Demori R, Montañes E, Erkonen G, Chance M, Anders M, Denfield S. Epidemiology of Pediatric Heart Failure in the USA-a 15-Year Multi-Institutional Study. Pediatr Cardiol 2021; 42:1297-1307. [PMID: 33871685 DOI: 10.1007/s00246-021-02611-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/07/2021] [Indexed: 11/30/2022]
Abstract
The epidemiology of pediatric heart failure (HF) has been characterized for congenital heart disease (CHD) and cardiomyopathies (CM), but the impact of CM associated with CHD has not been studied. This study aims to describe the characteristics and outcomes of inpatient pediatric HF patients with CHD, CM, and CHD with CM (CHD + CM) across the USA. We included all HF patients with CM diagnoses with and without CHD using ICD 9/10 codes ≤ 19 years old from January 2004 to September 2019 using the Pediatric Health Information System database. We identified 67,349 unique patients ≤ 19 years old with HF, of which 87% had CHD, 7% had CHD + CM, and 6% had CM. Pediatric HF admissions increased significantly from 2004 to 2018 with an associated increase in extracorporeal circulatory support (ECLS) use. Heart transplantation (HTX) increased only in the CHD and CHD + CM groups. CHD patients required less ECLS with and without HTX; however, they had significantly higher inpatient mortality after those procedures than the other groups (p < 0.001). CM patients were older (median 115 months) and had the lowest inpatient mortality after HTX with and without ECLS (p < 0.05). CHD + CM showed the highest overall inpatient mortality (15%), and cumulative hospital billed charges (median US$ 541,374), all p < 0.001. Pediatric HF admissions have increased from 2004 to 2018. ECLS use and HTX have expanded in this population, with an associated decrease in inpatient mortality in the CHD and CM groups. CHD + CM patients are a growing population with the highest inpatient mortality.
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Affiliation(s)
- Raysa Morales-Demori
- Department of Pediatrics, Division of Critical Care, Baylor College of Medicine, Texas Children's Hospital, 6651 Main St. MC E1420, Houston, TX, USA.
| | - Elena Montañes
- Department of Pediatrics, Division of Cardiology, Hospital 12 de Octubre, Madrid, Spain
| | - Gwen Erkonen
- Department of Pediatrics, Division of Critical Care, Baylor College of Medicine, Texas Children's Hospital, 6651 Main St. MC E1420, Houston, TX, USA
| | - Michael Chance
- Quality Outcomes & Analytics Specialist, Texas Children's Hospital, Houston, TX, USA
| | - Marc Anders
- Department of Pediatrics, Division of Critical Care, Baylor College of Medicine, Texas Children's Hospital, 6651 Main St. MC E1420, Houston, TX, USA
| | - Susan Denfield
- Department of Pediatrics, Division of Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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13
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Auerbach SR, Simpson KE. HVAD Usage and Outcomes in the Current Pediatric Ventricular Assist Device Field: An Advanced Cardiac Therapies Improving Outcomes Network (ACTION) Analysis. ASAIO J 2021; 67:675-680. [PMID: 33587465 DOI: 10.1097/mat.0000000000001373] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Advanced Cardiac Therapies Improving Outcomes Network (ACTION) is the first pediatric ventricular assist device (VAD) quality improvement network (46 centers). We aimed to describe outcomes with the HeartWare HVAD from ACTION centers. Patients with an HVAD implant in the ACTION registry (April 2018-April 2020) were analyzed. Baseline characteristics, adverse events, and survival were described. There were 50 patients implanted with a HVAD during the study period [36 cardiomyopathy, 8 congenital heart disease (CHD), and 6 other] and 21 (42%) had a prior sternotomy. Median age (range) was 12.9 years (3.4-19.1), body surface area was 1.3 m2 (0.56-2.62), and weight was 41.8 kg (12.8-135.3). Most were INTERMACS profile 2 (n = 26, 52%). Mechanical ventilation and ECMO were used pre-HVAD in 13 (26%) and 6 (12%), respectively. Median time on VAD was 71 (5-602) days. Survival was 96% at 1 year; 3 deaths were recorded, all of whom had CHD (p = 0.001). Neither ECMO nor mechanical ventilation were associated with death (p > 0.29). Most frequent AEs were bleeding (n = 7, 14%) and infection (n = 7, 14%). Stroke was rare (n = 2, 4%). ACTION Network HVAD outcomes were excellent, with 96% survival at 1 year and only 4% occurrence of stroke. Major bleeding and infection were the most common adverse events.
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Affiliation(s)
- Scott R Auerbach
- From the Children's Hospital of Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO
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14
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Sakai-Bizmark R, Webber EJ, Estevez D, Murillo M, Marr EH, Bedel LEM, Mena LA, Felix JCD, Smith LM. Health Care Utilization Due to Substance Abuse Among Homeless and Nonhomeless Children and Young Adults in New York. Psychiatr Serv 2021; 72:421-428. [PMID: 33789461 PMCID: PMC8106548 DOI: 10.1176/appi.ps.202000010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Substance abuse, particularly among homeless youths, is a significant public health challenge in the United States. Detailed data about health care utilization resulting from this preventable behavior remain sparse. This study aimed to compare health care utilization rates related to substance abuse among homeless and nonhomeless youths. METHODS A secondary data analysis evaluated records of homeless and nonhomeless patients under age 25 with a primary diagnosis of substance abuse, identified in 2013 and 2014 New York Statewide Inpatient and Emergency Department (ED) Databases. Outcomes included ED visit rate, hospitalization rate, in-hospital mortality, cost, length of stay (LOS), intensive care unit (ICU) utilization, and revisit or readmission rate. Multivariable regression models with a year fixed effect and facility random effect were used to evaluate the association between homelessness and each outcome. RESULTS A total of 68,867 cases included hospitalization or an ED visit related to substance abuse (68,118 nonhomeless and 749 homeless cases). Rates of ED visits related to substance abuse were 9.38 and 4.96, while rates of hospitalizations related to substance abuse were 10.53 and 1.01 per 1,000 homeless and nonhomeless youths, respectively. Homeless patients were more likely to utilize and revisit the ICU, be hospitalized or readmitted, incur higher costs, and have longer LOS than nonhomeless youths (all p<0.01). CONCLUSIONS The hospitalization and ED visit rates related to substance abuse were 10 and two times higher among homeless youths compared with nonhomeless youths, respectively. Detailed observation is needed to clarify whether homeless youths receive high-quality care for substance abuse when necessary.
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Affiliation(s)
- Rie Sakai-Bizmark
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California (all authors); Department of Pediatrics, David Geffen School of Medicine, Harbor-UCLA Medical Center, Torrance, California (Sakai-Bizmark, Smith)
| | - Eliza J Webber
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California (all authors); Department of Pediatrics, David Geffen School of Medicine, Harbor-UCLA Medical Center, Torrance, California (Sakai-Bizmark, Smith)
| | - Dennys Estevez
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California (all authors); Department of Pediatrics, David Geffen School of Medicine, Harbor-UCLA Medical Center, Torrance, California (Sakai-Bizmark, Smith)
| | - Mary Murillo
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California (all authors); Department of Pediatrics, David Geffen School of Medicine, Harbor-UCLA Medical Center, Torrance, California (Sakai-Bizmark, Smith)
| | - Emily H Marr
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California (all authors); Department of Pediatrics, David Geffen School of Medicine, Harbor-UCLA Medical Center, Torrance, California (Sakai-Bizmark, Smith)
| | - Lauren E M Bedel
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California (all authors); Department of Pediatrics, David Geffen School of Medicine, Harbor-UCLA Medical Center, Torrance, California (Sakai-Bizmark, Smith)
| | - Laurie A Mena
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California (all authors); Department of Pediatrics, David Geffen School of Medicine, Harbor-UCLA Medical Center, Torrance, California (Sakai-Bizmark, Smith)
| | - Jayde Clarice D Felix
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California (all authors); Department of Pediatrics, David Geffen School of Medicine, Harbor-UCLA Medical Center, Torrance, California (Sakai-Bizmark, Smith)
| | - Lynne M Smith
- The Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California (all authors); Department of Pediatrics, David Geffen School of Medicine, Harbor-UCLA Medical Center, Torrance, California (Sakai-Bizmark, Smith)
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15
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Modi ZJ, Waldo A, Selewski DT, Troost JP, Gipson DS. Inpatient Pediatric CKD Health Care Utilization and Mortality in the United States. Am J Kidney Dis 2021; 77:500-508. [PMID: 33058964 PMCID: PMC8485635 DOI: 10.1053/j.ajkd.2020.07.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 07/15/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE The impact of chronic kidney disease (CKD) on inpatient health care use is unknown. This study aimed to describe the prevalence of pediatric CKD among children hospitalized in the United States and examine the association of CKD with hospital outcomes. STUDY DESIGN Cross-sectional national survey of pediatric discharges. SETTING & PARTICIPANTS Hospital discharges of children (aged>28 days to 19 years) with a chronic medical diagnosis included in the Healthcare Cost and Utilization Project Kids' Inpatient Database for 2006, 2009, 2012, and 2016. PREDICTOR Presence of primary or coexisting CKD as identified by diagnosis codes. OUTCOMES Length of stay (LOS), cost, and mortality. ANALYTICAL APPROACH Multivariable analysis using Poisson, gamma, and logistic regressions were performed for LOS, cost, and mortality, respectively. RESULTS A chronic medical condition was present in 6,524,745 estimated discharges during the study period and CKD was present among 3.9% of discharges (96.1% without CKD). Those with CKD had a longer LOS (median of 2.8 [IQR, 1.4-6.0] days compared with 1.8 [IQR, 1.0-4.4] days for those without a CKD diagnosis; P<0.001). Median cost was higher in the CKD group compared with the group without CKD, at $8,755 (IQR, $4,563-18,345) and $5,016 (IQR, $2,860-10,109) per hospitalization, respectively (P<0.001). Presence of CKD was associated with a longer LOS (29.9% [95% CI, 27.2%-32.6%] longer than those without CKD), higher cost (61.3% [95% CI, 57.4%-65.4%] greater than those without CKD), and higher risk for mortality (OR, 1.51 [95% CI, 1.40-1.63]). LIMITATIONS Lack of access to and adjustment for confounders including patient readmission and laboratory data. CONCLUSIONS Pediatric CKD was associated with longer LOS, higher costs, and higher risk for mortality compared with hospitalizations with other chronic illnesses. Further studies are needed to better understand the health care needs and delivery of care to hospitalized children with CKD.
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Affiliation(s)
- Zubin J Modi
- Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI; Susan B. Meister Child Health Research and Evaluation Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI.
| | - Anne Waldo
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - David T Selewski
- Division of Pediatric Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Jonathan P Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI
| | - Debbie S Gipson
- Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI
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16
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Bongiorno DM, Badolato GM, Boyle M, Vernick JS, Levy JF, Goyal MK. United States trends in healthcare charges for pediatric firearm injuries. Am J Emerg Med 2021; 47:58-65. [PMID: 33773299 DOI: 10.1016/j.ajem.2021.03.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND From 2009 to 2016, >21,000 children died and an estimated 118,000 suffered non-fatal injuries from firearms in the United States. Limited data is available on resource utilization by injury intent. We use hospital charges as a proxy for resource use and sought to: 1) estimate mean charges for initial ED and inpatient care for acute firearm injuries among children in the U.S.; 2) compare differences in charges by firearm injury intent among children; and 3) evaluate trends in charges for pediatric firearm injuries over time, including within intent subgroups. METHODS In this repeated cross-sectional analysis of the 2009-2016 Nationwide Emergency Department Sample, we identified firearm injury cases among children aged ≤19 years using ICD-9-CM and ICD-10-CM external cause of injury codes (e-codes). Injury intent was categorized using e-codes as unintentional, assault-related, self-inflicted, or undetermined. Linear regressions utilizing survey weighting were used to examine associations between injury intent and healthcare charges, and to evaluate trends in mean charges over time. RESULTS Among 21,951 unweighted cases representing 102,072 pediatric firearm-related injuries, mean age was 16.6 years, and a majority were male (88.2%) and publicly insured (51.5%). Injuries were 53.9% assault-related, 37.7% unintentional, 1.8% self-inflicted, and 6.7% undetermined. Self-inflicted injuries had higher mean charges ($98,988) than assault-related ($52,496) and unintentional ($28,618) injuries (p < 0.001). Self-inflicted injuries remained associated with higher mean charges relative to unintentional injuries, after adjusting for patient demographics, hospital characteristics, and injury severity (p = 0.015). Mean charges for assault-related injuries also remained significantly higher than charges for unintentional injuries in multivariable models (p < 0.001). After adjusting for inflation, mean charges for pediatric firearm-related injuries increased over time (p-trend = 0.018) and were 23.1% higher in 2016 versus 2009. Mean charges increased over time among unintentional injuries (p-trend = 0.002), but not among cases with assault-related or self-inflicted injuries. CONCLUSIONS Self-inflicted and assault-related firearm injuries are associated with higher mean healthcare charges than unintentional firearm injuries among children. Mean charges for pediatric firearm injuries have also increased over time. These findings can help guide prevention interventions aimed at reducing the substantial burden of firearm injuries among children.
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Affiliation(s)
- Diana M Bongiorno
- Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Gia M Badolato
- Division of Emergency Medicine and Trauma Services, Children's National Health System, Washington, DC, United States of America.
| | - Meleah Boyle
- Division of Emergency Medicine and Trauma Services, Children's National Health System, Washington, DC, United States of America.
| | - Jon S Vernick
- Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Joseph F Levy
- Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America.
| | - Monika K Goyal
- Division of Emergency Medicine and Trauma Services, Children's National Health System and George Washington University, Washington, DC, United States of America.
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17
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The Creation of a Pediatric Health Care Learning Network: The ACTION Quality Improvement Collaborative. ASAIO J 2020; 66:441-446. [DOI: 10.1097/mat.0000000000001133] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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18
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Kim JJ. Cost utility of wearable cardioverter-defibrillators in children with dilated cardiomyopathy during medical optimization: Is it worth the wait? Heart Rhythm 2020; 17:294-295. [DOI: 10.1016/j.hrthm.2019.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Indexed: 11/30/2022]
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Peng DM, Rosenthal DN, Zafar F, Smyth L, VanderPluym CJ, Lorts A. Collaboration and new data in ACTION: a learning health care system to improve pediatric heart failure and ventricular assist device outcomes. Transl Pediatr 2019; 8:349-355. [PMID: 31728328 PMCID: PMC6825965 DOI: 10.21037/tp.2019.07.12] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Outcomes in pediatric heart failure and ventricular assist devices (VADs) remain suboptimal. Given the complexity and limited numbers, centers cannot be expected to acquire mastery and generalizable knowledge independently. Recognizing this problem, the community has formed Advanced Cardiac Therapies Improving Outcomes Network (ACTION), a collaborative learning health care system committed to unrelenting collaboration and continuous learning to improve critical outcomes in pediatric heart failure. ACTION is inclusive of all interested parties and believes the fastest and most effective way to make progress is through working together. ACTION's approaches to collaboration and data sharing will be highlighted.
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Affiliation(s)
- David M Peng
- Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - David N Rosenthal
- Betty Irene Moore Children's Heart Center, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Farhan Zafar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lauren Smyth
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christina J VanderPluym
- Department of Cardiology, Boston Children's Hospital, Harvard School of Medicine, Boston, MA, USA
| | - Angela Lorts
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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20
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Burch M, Nallagangula TK, Nic Lochlainn E, Severin T, Thakur L, Jaecklin T, George AT, Solar-Yohay S, Rossano JW, Shaddy RE. Systematic literature review on the economic, humanistic, and societal burden of heart failure in children and adolescents. Expert Rev Pharmacoecon Outcomes Res 2019; 19:397-408. [PMID: 30747011 DOI: 10.1080/14737167.2019.1579645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Unlike the adult heart failure (HF) patient population, there is scarce information on the overall burden of HF in the pediatric population across geographies and within different age groups. AREAS COVERED A systematic review aims to describe and quantify the economic, humanistic, and societal burden of pediatric (age <18 years) HF on patients and caregivers. Eighteen published studies over a period of 10 years (1 January 2006-20 May 2016) were identified through Embase, Medline, Cochrane Library and selected congresses. Studies from the US reported higher HF-related hospitalization-rates in infants aged <1 year (49.3%-63.9%) versus children aged 1-12 years (18.7%-30.9%) in HF diagnosed patients. Across the studies, the average length of hospital stay was 15 days, increasing to 26 days for infants. Average annual hospital charges were higher for infants (US$176,000) versus children aged 1-10 years (US$132,000) in the US. In Germany, diagnosis-related group (DRG)-based hospital-allowances per HF-case increased from €3,498 in 1995 to €4,250 in 2009. EXPERT OPINION To our knowledge, this is the first systematic review, which provides valuable insights into the burden of HF in children and adolescents, and strengthens current knowledge of pediatric HF. However, there is a need for larger population-based studies with wider geographical coverage.
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Affiliation(s)
- Michael Burch
- a Cardiorespiratory Division , Great Ormond Street Hospital for Children , London , UK
| | | | | | - Thomas Severin
- d Cardio-Metabolic Development Unit , Novartis Pharma AG , Basel , Switzerland
| | - Lalit Thakur
- b Health Economics and Outcomes Research , Novartis Healthcare Pvt. Ltd , Hyderabad , India
| | - Thomas Jaecklin
- e Global Clinical Development , Mirum Pharmaceuticals AG , Basel , Switzerland
| | - Aneesh Thomas George
- b Health Economics and Outcomes Research , Novartis Healthcare Pvt. Ltd , Hyderabad , India
| | - Susan Solar-Yohay
- f Cardio-Metabolic Development Unit , Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - Joseph W Rossano
- g Pediatric Cardiology, Children's Hospital of Philadelphia , University of Pennsylvania Perelman School of Medicine , Philadelphia, PA , USA
| | - Robert E Shaddy
- h Pediatric Cardiology , Children's Hospital Los Angeles and Keck School of Medicine of USC , Los Angeles, CA , USA
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Patient characteristics and incidence of childhood hospitalisation due to hypertrophic cardiomyopathy in the United States of America 2001-2014. Cardiol Young 2019; 29:344-354. [PMID: 30907336 DOI: 10.1017/s1047951118002421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study investigated patient characteristics in paediatric hospitalisations for hypertrophic cardiomyopathy. We used Nationwide Inpatient Sample, which is the largest all-payer inpatient database in the United States, yielding nationally representative estimates, from 2001 to 2014. ICD-9-CM diagnostic codes identified hospitalisations for patients with hypertrophic cardiomyopathy and <18 years. Outcomes included yearly rate of hospitalisation, death, admission via emergency department, and need for surgery. Predictors of interest were age groups (<1, 1-9, and ⩾10 y/o), sex, and race/ethnicity. Logistic regression modelled associations, adjusted by patient- and hospital-level variables. With 2302 weighted hospitalisations, hospitalisation rates were 0.22 per 100,000 children/year, with higher rates for <1 y/o (0.42) and ⩾10 y/o (0.31). Male-to-female ratios were more prominent in the oldest age group; 2.7:1 in ⩾10 y/o versus less than 1.7:1 for <10 y/o. In-hospital mortality was 1.5%, with highest mortality rates among the <1 y/o (6.3%). Children ⩾10 y/o had 5.59 times higher risk of admission from the emergency department than 1-9 y/o age group. Both ⩾10 and <1 y/o age groups had lower risk of surgical intervention compared to the 1-9 y/o group with odds ratio 0.56 and 0.26, respectively. Black children had higher risk of admission from the emergency department than White children with odds ratio 2.78. A relation between age group and sex was observed, with sex-based differences in prevalence and treatment of hypertrophic cardiomyopathy becoming more pronounced with age. Further studies are needed to clarify mechanisms behind age and racial disparity in hospitalisation, especially admission source.
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22
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Burstein DS, Shamszad P, Dai D, Almond CS, Price JF, Lin KY, O’Connor MJ, Shaddy RE, Mascio CE, Rossano JW. Significant mortality, morbidity and resource utilization associated with advanced heart failure in congenital heart disease in children and young adults. Am Heart J 2019; 209:9-19. [PMID: 30639612 DOI: 10.1016/j.ahj.2018.11.010] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/27/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Children with congenital heart disease (CHD) are at risk for advanced heart failure (AHF). We sought to define the mortality and resource utilization in CHD-related AHF in children and young adults. METHODS All hospitalizations in the Pediatric Health Information System database involving patients ≤21 years old with a CHD diagnosis and heart failure requiring at least 7 days of continuous inotropic support between 2004 and 2015 were included. Hospitalizations including CHD surgery were excluded. RESULTS Of 465,482 CHD hospitalizations, AHF was present in 2,712 (0.6%) [58% infant, 55% male, 30% single ventricle]. AHF therapies frequently used included extracorporeal membrane oxygenation (ECMO) (15%) and cardiac transplant (16%). Ventricular assist device (VAD) support was rare (3%), although VAD use significantly increased from 2004 to 2015 (P < .0010). Hospital mortality in CHD with AHF was 26%, with higher mortality associated with single ventricle heart disease (OR 1.64, 95% CI 1.23-2.19; P = .0009), infancy (OR 1.71, 95% CI 1.17-2.5; P = .0057), non-white race (OR 1.28, 95% CI 1.04-1.59; p=0.0234), and chronic complex comorbidities (OR 1.76, 95% CI 1.34-2.30; P < .0001). Over the 11-year study period, despite the significant increase in CHD-related AHF hospitalizations (P < .0001), hospital mortality improved (P = .0011). Median hospital costs were $252,000, a 6-fold increase above those without AHF, and was primarily driven by hospital length of stay (P < .0001). CONCLUSION AHF in children with CHD in uncommon but increasing and is associated with significant morbidity, mortality and resource utilization. Approximately 1 in 5 children do not survive to hospital discharge. Many risk factors for mortality may not be modifiable, and further study is needed to identify modifiable risk factors and improve care for this complex population.
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23
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Rossano JW, Cantor RS, Dai D, Shamszad P, Huang YS, Hall M, Lin KY, Edens RE, Parrino PE, Kirklin JK. Resource Utilization in Pediatric Patients Supported With Ventricular Assist Devices in the United States: A Multicenter Study From the Pediatric Interagency Registry for Mechanically Assisted Circulatory Support and the Pediatric Health Information System. J Am Heart Assoc 2018; 7:JAHA.117.008380. [PMID: 29858364 PMCID: PMC6015374 DOI: 10.1161/jaha.117.008380] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Few data exist on resource utilization with pediatric ventricular assist devices (VADs). We tested the hypothesis that device type and adverse events are associated with increased resource utilization in pediatric patients supported with VADs. Methods and Results The Pediatric Interagency Registry for Mechanically Assisted Circulatory Support, a national registry of VADs in patients <19 years old, and the Pediatric Health Information System, an administrative database, were merged. Univariate analysis was performed assessing the association of all factors with the total cost and length of stay first. Significant variables (P<0.05) were subjected to multivariable analysis. The study included 142 patients from 19 centers with VAD implants from October 2012 to June 2016. The median age was 9 years (interquartile range [IQR] 2‐15), 84 (59%) supported with a continuous‐flow VAD. Overall median hospital costs were $750 000 (IQR $539 000 to $1 100 000) with a median hospital length of stay of 81 days (IQR 54‐128). On multivariable analysis, device type and postoperative complications were not associated with resource utilization. Factors associated with increased costs included patient age, lower‐volume VAD center, being intubated, being on extracorporeal membrane oxygenation, number of complex chronic medical conditions, and length of stay. Among continuous‐flow VAD patients, discharge to home before transplant versus remaining hospitalized was associated with lower hospital costs (median $600 000 [IQR $400 000 to $820 000] versus median $680 000 [IQR $500 000 to $970 000], P=0.03). Conclusion VADs in pediatric patients are associated with high resource utilization. Increased resource utilization was associated with lower‐volume VAD centers, disease severity at VAD implantation, and the presence of complex chronic medical conditions. Further study is needed to develop cost‐effective strategies in this complex population.
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Affiliation(s)
- Joseph W Rossano
- The Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA .,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Ryan S Cantor
- Cardiothoracic Surgery, The University of Alabama at Birmingham, AL
| | - Dingwei Dai
- Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness and PolicyLab, The Children's Hospital of Philadelphia, PA
| | - Pirouz Shamszad
- The Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Yuan-Shung Huang
- Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness and PolicyLab, The Children's Hospital of Philadelphia, PA
| | | | - Kimberly Y Lin
- The Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - James K Kirklin
- Cardiothoracic Surgery, The University of Alabama at Birmingham, AL
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24
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Nandi D, Rossano JW, Wang Y, Jerrell JM. Risk Factors for Heart Failure and Its Costs Among Children with Complex Congenital Heart Disease in a Medicaid Cohort. Pediatr Cardiol 2017; 38:1672-1679. [PMID: 28852817 DOI: 10.1007/s00246-017-1712-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 08/09/2017] [Indexed: 01/05/2023]
Abstract
Little research attention has been paid to the occurrence of heart failure (HF) in children with complex congenital heart diseases (CHDs). Herein, we describe the prevalence, risk factors, and costs associated with HF in complex CHD. Patients aged ≤17 years and diagnosed with a complex CHD on multiple service visits over a 15-year period in the SC Medicaid dataset (1996-2010) were tracked and analyzed. The cohort included 2999 unduplicated patients; 51.0% were male; 34.4% were African American. HF was diagnosed in 7.6%. Single ventricle lesions, genetic syndromes, and ventricular arrhythmia were significantly associated with an increased likelihood of being diagnosed with HF, controlling for development of comorbid pulmonary hypertension. Patients with HF received significantly more subspecialty care, more surgeries, more hospitalizations, more total days of inpatient care, and more emergency department care than those without HF. Patients with significantly higher total care costs paid by Medicaid had HF, more cardiac surgeries, and more specialized mechanical or other support procedures, controlling for diagnosed single ventricle CHD, a genetic syndrome, and number of non-cardiac surgeries. Complex CHD patients with HF incur significantly higher care costs but require multifaceted, intensive supports for management of incident complications and comorbid conditions.
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Affiliation(s)
- Deipanjan Nandi
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Joseph W Rossano
- The Cardiac Center, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Yinding Wang
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Jeanette M Jerrell
- Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, 15 Medical Park, Suite 301, Columbia, SC, 29203, USA.
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Hayanga JA, Shigemura N, Aboagye JK, Ensor C, Dew MA, Hayanga HK, Esper SA, Joubert K, Morrell MR, D'Cunha J. ECMO Support in Lung Transplantation: A Contemporary Analysis of Hospital Charges in the United States. Ann Thorac Surg 2017; 104:1033-1039. [DOI: 10.1016/j.athoracsur.2017.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 03/25/2017] [Accepted: 04/03/2017] [Indexed: 11/25/2022]
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26
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Fernandes BA, Maher KO, Deshpande SR. Cardiac biomarkers in pediatric heart disease: A state of art review. World J Cardiol 2016; 8:719-727. [PMID: 28070239 PMCID: PMC5183971 DOI: 10.4330/wjc.v8.i12.719] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/27/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
Every year there are more than 11000 hospitalizations related to heart failure in children resulting in significant morbidity and mortality. Over the last two decades, our understanding, diagnosis and management of pediatric heart failure is evolving but our ability to prognosticate outcomes in pediatric heart acute heart failure is extremely limited due to lack of data. In adult heart failure patients, the role of cardiac biomarkers has exponentially increased over the last two decades. Current guidelines for management of heart failure emphasize the role of cardiac biomarkers in diagnosis, management and prognostication of heart failure. It is also noteworthy that these biomarkers reflect important biological processes that also open up the possibility of therapeutic targets. There is however, a significant gap present in the pediatric population with regards to biomarkers in pediatric heart failure. Here, we seek to review available data regarding cardiac biomarkers in the pediatric population and also explore some of the emerging biomarkers from adult literature that may be pertinent to pediatric heart failure.
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