Abstract 11975: The Burden of Heart Failure Related Hospitalizations in Children with Single Ventricle Heart Disease in the United States
Introduction: As more children survive palliation of single ventricle heart disease (SVHD), many have co-morbid heart failure. However, few data exist on heart failure in this population.
Hypothesis: SVHD patients with heart failure related hospitalizations (HFRH) are at increased risk of death compared to those with non-HFRH, and non-cardiac morbidities are associated with an increased risk of death.
Methods: A retrospective review of the Health Care Cost and Utilization Project Kids Inpatient Database (KID) was performed for the years 2000, 2003, and 2006. The KID is a nationwide sampling of pediatric hospitalizations and is weighted to provide national estimates. Pediatric patients (age ≤ 20) with the diagnoses of heart failure and tricuspid atresia, hypoplastic left heart syndrome, or univentricular heart were included.
Results: There were 732 (95% CI 339 - 1,226) HFRH in SVHD patients in 2000 and 1,168 (95% CI 771 - 1,563) in 2006 (p=0.21), which represented 10.6% and 13.6% of all SVHD admissions, respectively. Most patients were infants (63%) and underwent a cardiac surgical or interventional procedure (59%). Among SVHD patients, hospital length of stay (LOS) was nearly twice as long in HFRH (mean 22.4, 95% CI 19.7-25.0) compared to non-HFRH (mean 11.3, 95% CI 10.7-11.9) and mortality was 50% greater among patients with HRFH (12.2%) compared to non-HFRH (7.9%) (OR 1.6, 95% CI 1.3-2.1). Morbidities tended to be more common among SVHD patients with HFRH compared to non-HFRH including arrhythmias (16.3% vs 12.5%, p=0.006), sepsis (13.0% vs 7.0%, p<0.001), and respiratory failure (10.0% vs 3.3%, p<0.001). Among SVHD patients with HFRH, factors associated with hospital mortality on multivariable analysis included cerebrovascular disease (OR 5.19, 95% CI 2.48-10.87), acute renal failure (OR 6.79, 95% CI 3.69 -12.51), sepsis (OR 2.86, 95% CI 1.97-4.17), and the use of extracorporeal membrane oxygenation (ECMO) (OR 10.32, 95% CI 6.71-15.88).
Conclusions: HFRH comprise > 10% of all SVHD admissions and are associated with increased LOS and mortality. Non-cardiac morbidities and the use of ECMO are independently associated with hospital mortality. Further study is warranted to define modifiable risk factors and improve the care of this complex group of patients.
- © 2012 by American Heart Association, Inc.