Javier J Lasa1,2, Michael Gaies3, Lauren Bush4, Wenying Zhang4, Mousumi Banerjee5, Jeffrey A Alten6, Ryan J Butts7, Antonio G Cabrera2, Paul A Checchia1, Justin Elhoff1, Angela Lorts6, Joseph W Rossano8, Kurt Schumacher3, Lara S Shekerdemian1, Jack F Price2. 1. Division of Critical Care Medicine (J.J.L., P.A.C., J.E., L.S.S.), Texas Children's Hospital, Baylor College of Medicine, Houston. 2. Division of Cardiology (J.J.L., A.G.C., J.F.P.), Texas Children's Hospital, Baylor College of Medicine, Houston. 3. Department of Pediatrics, University of Michigan Medical School, Ann Arbor (M.G., K.S.). 4. PC Data Coordinating Center, Michigan Congenital Heart Outcomes Research and Discovery Unit, University of Michigan, Ann Arbor (L.B., W.Z.). 5. Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor (M.B.). 6. Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, OH (J.A.A., A.L.). 7. UT Southwestern Department of Pediatrics, Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (R.J.B.). 8. Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine (J.W.R.).
Abstract
BACKGROUND: Acute decompensated heart failure (ADHF) is a highly morbid condition among adults. Little is known about outcomes in children with ADHF. We analyzed the Pediatric Cardiac Critical Care Consortium registry to determine the epidemiology, contemporary treatments, and predictors of mortality in critically ill children with ADHF. METHODS: Cardiac intensive care unit (CICU) patients ≤18 years of age meeting Pediatric Cardiac Critical Care Consortium criteria for ADHF were included. ADHF was defined as systolic or diastolic dysfunction requiring continuous vasoactive or diuretic infusion, respiratory support, or mechanical circulatory support. Demographics, diagnosis, therapies, complications, and mortality are described for the cohort. Predictors of CICU mortality were identified using logistic regression. RESULTS: Among 26 294 consecutive admissions (23 centers), 1494 (6%) met criteria for analysis. Median age was 0.93 years (interquartile range, 0.1-9.3 years). Patients with congenital heart disease (CHD) comprised 57% of the cohort. Common therapies included the following: vasoactive infusions (88%), central venous catheters (86%), mechanical ventilation (59%), and high flow nasal cannula (46%). Common complications were arrhythmias (19%), cardiac arrest (10%), sepsis (7%), and acute renal failure requiring dialysis (3%). Median length of CICU stay was 7.9 days (interquartile range, 3-18 days) and the CICU readmission rate was 22%. Overall, CICU mortality was 15% although higher for patients with CHD versus non-CHD (19% versus 11%; P<0.001). Independent risk factors associated with CICU mortality included age <30 days, CHD, vasoactive infusions, ventricular tachycardia, mechanical ventilation, sepsis, pulmonary hypertension, extracorporeal membrane oxygenation, and cardiac arrest. CONCLUSIONS: ADHF in children is characterized by comorbidities, high mortality rates, and frequent readmission, especially among patients with CHD. Opportunities exist to determine best practices around appropriate use of mechanical support, cardiac arrest prevention, and optimal heart transplantation candidacy to improve outcomes for these patients.
BACKGROUND: Acute decompensated heart failure (ADHF) is a highly morbid condition among adults. Little is known about outcomes in children with ADHF. We analyzed the Pediatric Cardiac Critical Care Consortium registry to determine the epidemiology, contemporary treatments, and predictors of mortality in critically illchildren with ADHF. METHODS: Cardiac intensive care unit (CICU) patients ≤18 years of age meeting Pediatric Cardiac Critical Care Consortium criteria for ADHF were included. ADHF was defined as systolic or diastolic dysfunction requiring continuous vasoactive or diuretic infusion, respiratory support, or mechanical circulatory support. Demographics, diagnosis, therapies, complications, and mortality are described for the cohort. Predictors of CICUmortality were identified using logistic regression. RESULTS: Among 26 294 consecutive admissions (23 centers), 1494 (6%) met criteria for analysis. Median age was 0.93 years (interquartile range, 0.1-9.3 years). Patients with congenital heart disease (CHD) comprised 57% of the cohort. Common therapies included the following: vasoactive infusions (88%), central venous catheters (86%), mechanical ventilation (59%), and high flow nasal cannula (46%). Common complications were arrhythmias (19%), cardiac arrest (10%), sepsis (7%), and acute renal failure requiring dialysis (3%). Median length of CICU stay was 7.9 days (interquartile range, 3-18 days) and the CICU readmission rate was 22%. Overall, CICUmortality was 15% although higher for patients with CHD versus non-CHD (19% versus 11%; P<0.001). Independent risk factors associated with CICUmortality included age <30 days, CHD, vasoactive infusions, ventricular tachycardia, mechanical ventilation, sepsis, pulmonary hypertension, extracorporeal membrane oxygenation, and cardiac arrest. CONCLUSIONS:ADHF in children is characterized by comorbidities, high mortality rates, and frequent readmission, especially among patients with CHD. Opportunities exist to determine best practices around appropriate use of mechanical support, cardiac arrest prevention, and optimal heart transplantation candidacy to improve outcomes for these patients.
Entities:
Keywords:
critical care; demography; heart failure; pediatrics; quality of care
Authors: Gregg C Fonarow; J Thomas Heywood; Paul A Heidenreich; Margarita Lopatin; Clyde W Yancy Journal: Am Heart J Date: 2007-06 Impact factor: 4.749
Authors: Pirouz Shamszad; Matthew Hall; Joseph W Rossano; Susan W Denfield; Jarrod D Knudson; Daniel J Penny; Jeffrey A Towbin; Antonio G Cabrera Journal: J Card Fail Date: 2013-10 Impact factor: 5.712
Authors: Kirkwood F Adams; Gregg C Fonarow; Charles L Emerman; Thierry H LeJemtel; Maria Rosa Costanzo; William T Abraham; Robert L Berkowitz; Marie Galvao; Darlene P Horton Journal: Am Heart J Date: 2005-02 Impact factor: 4.749
Authors: Lisa Bergersen; Allen Dale Everett; Jorge Manuel Giroud; Gerard R Martin; Rodney Cyril George Franklin; Marie Josée Béland; Otto Nils Krogmann; Vera Demarchi Aiello; Steven D Colan; Martin J Elliott; J William Gaynor; Hiromi Kurosawa; Bohdan Maruszewski; Giovanni Stellin; Christo I Tchervenkov; Henry Lane Walters; Paul Weinberg; Jeffrey Phillip Jacobs Journal: Cardiol Young Date: 2011-02-11 Impact factor: 1.093
Authors: Veli-Pekka Harjola; Ferenc Follath; Markku S Nieminen; Dirk Brutsaert; Kenneth Dickstein; Helmut Drexler; Matthias Hochadel; Michel Komajda; Jose L Lopez-Sendon; Piotr Ponikowski; Luigi Tavazzi Journal: Eur J Heart Fail Date: 2010-03 Impact factor: 15.534
Authors: William T Abraham; Gregg C Fonarow; Nancy M Albert; Wendy Gattis Stough; Mihai Gheorghiade; Barry H Greenberg; Christopher M O'Connor; Jie Lena Sun; Clyde W Yancy; James B Young Journal: J Am Coll Cardiol Date: 2008-07-29 Impact factor: 24.094
Authors: Elizabeth D Blume; David N Rosenthal; Joseph W Rossano; J Timothy Baldwin; Pirooz Eghtesady; David L S Morales; Ryan S Cantor; Jennifer Conway; Angela Lorts; Christopher S Almond; David C Naftel; James K Kirklin Journal: J Heart Lung Transplant Date: 2016-02-10 Impact factor: 10.247
Authors: Sharon Chen; John C Dykes; Doff B McElhinney; Robert J Gajarski; Andrew Y Shin; Seth A Hollander; Melanie E Everitt; Jack F Price; Ravi R Thiagarajan; Steven J Kindel; Joseph W Rossano; Beth D Kaufman; Lindsay J May; Elizabeth Pruitt; David N Rosenthal; Christopher S Almond Journal: Eur Heart J Date: 2017-10-07 Impact factor: 29.983
Authors: Emily Morell; Mary Katherine Miller; Minmin Lu; Kevin G Friedman; Roger E Breitbart; Jeffrey R Reichman; Julie McDermott; Lynn A Sleeper; Elizabeth D Blume Journal: J Am Heart Assoc Date: 2021-01-14 Impact factor: 5.501