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Extant epidemiologic results for pediatric congenital heart disease (CHD) are dated. Given the degree of variability in previous prevalence estimates and the rapid changes in pediatric cardiology diagnostic and treatment procedures, a reexamination of these rates represents a potentially important update in this area of inquiry. This report characterizes the prevalence rates of children with CHD in one state's treated pediatric population by type of lesion and in comparison with published rates from previous studies. Two 15-year data sets (1996-2010) are analyzed. The inclusion criteria for the study required the participants to be 17 years or younger, enrollees in the South Carolina State Medicaid or State Health Plan, and recipients of a CHD diagnosis on one or more service visits to a pediatrician or pediatric cardiologist. A 15-year accrued prevalence rate for pediatric CHD of 16.7 per 1,000 was found among 1,145,364 unduplicated children served. The annual incidence rates varied from 6.3 to 8.6 per 1,000, with an initial downward trend from 1996 to 2002 followed by an upward trend from 2003 to 2008. A higher prevalence of atrioventricular canal/endocardial cushion defects, common/single ventricle, double-outlet right ventricle, tetralogy of Fallot, and truncus arteriosus and a lower prevalence of dextro-transposition of the great arteries were diagnosed in South Carolina than in other states and countries according to published results. The study results underscore the need for periodic updating of prevalence data for pediatric CHD, both in total and for specific lesions, to anticipate and provide more specialized care to young patients with CHD, especially in the more rare and complex cases.

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Background : Data suggests that same day discharge after implantation of trans-venous pacemakers is safe and feasible. We sought to determine whether same day discharge was feasible and safe following implantation of Medtronic MICRA leadless pacemakers. Methods : We retrospectively identified all patients undergoing MICRA placement at our institution between April 2014 to August 2018 (n=167). Patients were stratified into two groups: those discharged on the same day as their procedure (SD, n=25), and those observed for at least one night in the hospital (HD, n=142). The primary endpoint included a composite of major complications including: access site complications, new pericardial effusion, device dislodgement, and need for device revision up to approximately 45 days of follow up. Results : SD and HD had similar age (75±13 vs. 75±13 years, p=0.923), prevalence of male sex (49 vs. 44%, p=0.669), and frequency of high-grade heart block as an indication for pacing (38 vs. 32%, p=0.596). There were more Caucasians in the SD group (72 vs. 66%, p=0.038). The rate of the composite endpoint was statistically non-significantly higher in the HD group (3.5% vs. 0.0%, p=1.00). The rates of each individual components comprising the composite endpoint were similar between groups. Conclusions : Our data suggest that in appropriately selected patients, same day discharge can occur safely following Micra leadless pacemaker implantation.

Background Widespread use of echocardiography has made earlier diagnosis of patent ductus arteriosus (PDA) possible, but pharmacological or surgical intervention is highly variable. Herein, we investigate the prevalence of PDA and its management in a routine care system. Methods A 15‐year retrospective dataset (1996–2010) was analyzed. Selection criteria included age ≤17 years, enrollees in South Carolina State Medicaid, and diagnosed as having PDA on 1 or more service visits to a pediatrician or pediatric cardiologist. Results The 15‐year treated prevalence rate of PDA was 0.25/1000 pediatric cases of congenital heart disease (CHD). PDA was more prevalent in non‐African American patients (adjusted odds ratio [aOR]: 1.12), but not in females after controlling for all other CHDs diagnosed in the cohort. Associated CHDs were present in 57.6% of the cases, primarily atrial or ventricular septal defects, and fewer patients (5.5%) developed pulmonary hypertension. Of 3627 PDA cases examined, 70.0% received no medications or PDA repair. Therapeutic ibuprofen was used for closure in 24.4% of the cases, and a PDA repair was performed in 7.8%. Younger children (aOR: 0.82), those who received an atrial septal defect closure (aOR: 5.18), and those who were treated with digoxin (aOR: 1.86) or with diuretics or preload/afterload reducing agents (ie, calcium channel blockers or angiotensin‐converting enzyme inhibitors) (aOR: 5.72) were significantly more likely to have a PDA repair procedure. Conclusions The majority of diagnosed PDA cases did not require pharmacological or surgical intervention. Those receiving pharmacological or surgical intervention were treated conservatively in relation to the presence of distress symptoms or concomitant CHDs requiring intervention.

Since 2003, the U.S. Food and Drug Administration as well as the American Diabetes Association, the American Psychiatric Association, and others have called for routine monitoring of cardiometabolic risk factors for patients of all ages prescribed second-generation antipsychotic medications. This survey of major public and private mental health treatment systems in 2010 found that adherence to such guidelines was limited. The authors describe some of the impediments to widespread monitoring of cardiometabolic risk factors among psychiatric patients taking second-generation antipsychotics and advocate for a nationwide commitment to providing the organizational and financial supports necessary to ensure systematic screening of cardiometabolic health among such patients.

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Changes over time in pediatric CHD caseload mix may affect care management and result in prognosis or outcome differences. These changes present important opportunities for pediatricians and pediatric cardiologists to collaborate, especially in the care of the most severe anomalies.