Abstract 2003: Prevalence of Heart Failure Related Hospitalizations and Risk Factors for Mortality in Pediatric Patients: An Analysis of a Nationwide Sampling of Hospital Discharges
Introduction: Heart failure (HF) is among the most frequent causes of hospitalization for adult patients, and is associated with significant morbidity and mortality. However, there are very limited data regarding the frequency or mortality associated with pediatric HF admissions.
Hypothesis: We assessed the hypothesis that pediatric HF would be an uncommon reason for hospital admission, but would be associated with significant mortality. Risk factors for mortality were also assessed.
Methods: A retrospective analysis of the Healthcare Cost and Utilization Project Kids’ Inpatient Database, a nationwide database of pediatric hospital discharges that is weighted to provide national estimates, was performed to determine the prevalence of HF hospitalizations in 2003 and the effect of HF hospitalizations on mortality using weighted values.
Results: There were 12,683 pediatric HF hospitalizations, representing 0.2% of all pediatric hospitalizations. Most (62%) patients were < 1 year-old and 21% were ≥ 13 years-old. Underlying diagnoses for HF included congenital heart disease (CHD) (58.5%), cardiomyopathy (17.8), and myocarditis (2.7%). Interventions during hospitalization included cardiac surgical or catheter procedures (32.9%), ECMO (1.8%), and heart transplantation (1.7%). Mortality prior to hospital discharge occurred in 7.0% (95% CI 6.0% to 8.2%) of HF patients compared to 0.4% (95% CI 0.3% to 0.4%) of patients without HF (OR 20.6, 95% CI 17.4 to 24.4). Risk factors for mortality on multivariable analysis included not undergoing a cardiac intervention (OR 1.5, 95% CI 1.1 to 2.1), stroke or seizure (OR 1.7, 95% CI 1.2 to 2.4), sepsis (OR 2.7, 95% CI 2.1 to 3.6), acute renal failure (ARF) (OR 4.1, 95% CI 3.0 to 5.5), respiratory failure (OR 4.1, 95% CI 3.2 to 5.2), and undergoing ECMO (OR 11.6, 95% CI 7.0 to 19.2). Age and underlying diagnosis of CHD, cardiomyopathy, or myocarditis were not associated with mortality.
Conclusions: In this largest study on pediatric HF hospitalizations, admissions for pediatric HF represent a small but significant proportion of all pediatric hospital admissions, and are associated with an over 20 times increase in the risk of death. Independent predictors of mortality include respiratory failure, ARF, and undergoing ECMO.