Abstract 9251: Increasing Prevalence and Decreasing Mortality in Pulmonary Hypertension Related Hospitalizations in the United States: An Analysis of Over 20,000 Hospital Admissions
Introduction: Pulmonary hypertension (PH) is a serious but uncommon disorder. However, few large scale data exist on the prevalence or mortality associated with PH hospitalizations in children. Risk factors for hospital mortality are also unknown.
Hypothesis: The prevalence of pediatric PH admissions has increased, but the mortality has decreased, over the 7-year period from 2000 - 2006.
Methods: A retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database was performed for pediatric (age ≤ 20 years) PH related admissions for the years 2000, 2003, and 2006. The database is a nationwide sampling of pediatric hospital discharges and is weighted to provide national estimates.
Results: In 2000 there were 7,348 (95%CI 6,176 to 8,521) pediatric PH related admissions and in 2006 there were 9,378 (95%CI 8,068 to 10,687) admissions (p<0.001). Congenital heart disease was the most common associated diagnosis in all years (range 46.5% to 50.4%). Bronchopulmonary dysplasia (BPD) with PH increased over time from 4.2% in 2000 to 10.2% in 2006 (p<0.001). Several comorbidities increased over time including sepsis, acute renal failure, and respiratory failure (p<0.05 for all). Overall hospital mortality was greater for patients with PH (6.2%) compared to patients without PH (0.4%) (OR 17.7, 95%CI 16.1 to 19.4). Mortality for PH patients decreased over time from 7.7% in 2000 to 4.8% in 2006 (p<0.001). Mortality was greatest among infants (8.2%), those with BPD (9.5%), respiratory failure (19.9%), renal failure (38.2%), and with extracorporeal membrane oxygenation (ECMO) (34.1%). On multivariable analysis, factors associated with increased mortality included earlier year (OR 2.0, 95% CI 1.6 to 2.5), respiratory failure (OR 4.5, 95% CI 3.6 to 5.7), ECMO (OR 4.8, 95% CI 3.1 to 7.4), and acute renal failure (OR 6.3, 95% CI 4.2 to 9.4).
Conclusions: There were 2,000 more PH related hospitalizations in children in 2006 than in 2000. Comorbidities increased over this time period; however, hospital mortality decreased over 60%. These findings have critical implications for pediatric hospital utilization and planning. Increased off-label application of PH pharmacotherapeutic agents may have contributed to the improved survival.
- © 2011 by American Heart Association, Inc.