Characterizing Inpatient Mortality in Pediatric HF

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In published research, pediatric heart failure (HF) has received less attention than adult HF regarding its etiology, management, and patient outcomes, explains Ebenezer O. Adebiyi, MD, MPH. Studies have shown that adult HF is mostly caused by cardiovascular conditions, but pediatric HF can be triggered by both cardiovascular and non-cardiovascular abnormalities. Of note, congenital heart disease (CHD) and cardiomyopathy have been identified as important causes of pediatric HF.

Recent advances in surgical and catheter techniques for CHD repair and improvements in intensive care management have helped increase survivorship for many children with CHD into adulthood. Cardiomyopathy in pediatric HF can result from several factors, such as coronary artery abnormalities, toxins, infections, and/or underlying comorbidities.

Rate of Pediatric HF-Related In-Hospital Deaths Decreasing

Nearly a decade ago, a study estimated that the pediatric HF-related in-hospital mortality rate was 7.3%. “This rate might be decreasing since there have been significant improvements in both the operative and perioperative care of children with CHD as well as in the general management of pediatric HF over the last decade,” says Dr. Adebiyi, adding that no study to date has described the primary diagnoses among pediatric patients with HF who died while being admitted into hospitals in the United States.

For a study published in Cureus, Dr. Adebiyi and colleagues sought to determine the current in-hospital mortality in the US and the principal diagnoses of pediatric patients with HF who died while being hospitalized. The study used data from the 2019 Kid Inpatient Database, which contained information on hospitalized patients younger than 21. The data were searched for HF diagnoses using ICD-10-CM codes. In total, data were examined on 16,206 pediatric HF admissions from a total weight of 7 million US pediatric hospitalizations in 2019.

Most Pediatric Patients with HF Died of Non-Cardiac Causes

The study showed that 6.31% of pediatric patients with HF admitted to the hospital died during their admission. Among these people, male and White individuals had higher mortality rates, and most patients had at least one comorbidity. Most patients (58%) were children younger than 2, compared with children aged 2 to 12 (~18%) and those between 13 and 21 (~24%). Among individuals with pediatric HF, the average length of stay was 33.77 days and the total hospital charges were $1,037,099.

The top five principal ICD 10 code categories among all pediatric HF deaths were 1) circulatory system (17.95%), 2) congenital/chromosomal abnormalities (17.43%), 3) respiratory system (10.28%), 4) infectious diseases (9.24%), and 5) perinatal diseases (7.90%). Sepsis of unspecified organisms (5.14%), hypoplastic left heart syndrome (3.19%), and acute respiratory failure with hypoxia (3.14%) were the most common primary diagnoses among all pediatric HF deaths.

Efforts Warranted for Continued Improvements

“The overall pediatric HF in-hospital mortality rate observed in our study was slightly lower than what was seen nearly a decade ago, suggesting a positive decreasing trend over time,” Dr. Adebiyi says. “Most pediatric patients with HF died from non-cardiac causes.” Importantly, sepsis of an unspecified organism and acute on chronic systolic HF were the leading diagnoses in children older than 2 who died of HF.” Whiles sepsis constituted 8% of all primary diagnoses among children aged 2 to 12, it accounted for 11.59% of all primary diagnoses in children aged 13 to 20 (Table).

Results of the study provide a better understanding of the current burden of pediatric HF in the US and highlight areas that can be targeted to improve outcomes for children with HF in the US. “While it’s encouraging that pediatric HF patients are experiencing better outcomes, there is still room for improvement,” says Dr. Adebiyi.

Since sepsis was identified as a significant cause of morbidity and mortality in pediatric HF, Dr. Adebiyi says that preventive measures and prompt treatment of infections are paramount to reducing in-hospital mortality. “We also need strategies to improve how pediatric patients with HF should be managed, such as single ventricle monitoring programs,” adds Dr. Adebiyi. “Such efforts may significantly reduce overall mortality in pediatric HF.”

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