Epidemiology of Heart Failure in a Tertiary Pediatric Center

Abstract

Background: In contrast to the adult age group, epidemiologic studies on heart failure (HF) in the pediatric population are lacking. The aim of this prospective study was to analyze the epidemiology of HF during infancy and childhood. Methods: Of the 1,196 children with congenital and acquired heart diseases, primarily diagnosed during a 10-y period in one hospital, we identified those patients who developed HF. Results: Within 10 y, 1,196 children with heart disease were indexed. Heart failure occurred in 124 of these patients (10.4%): 64 out of 1,031 children with congenital heart diseases (6.2%), 13 out of 96 children with rhythm or conduction disturbances (13.5%), 23 out of 39 children with acquired heart diseases (59.0%), and 24 out of 30 children with cardiomyopathies (80.0%). Heart failure occurred in 72 cases (58.1%) during the first year of life. The incidence in infancy was much more pronounced for congenital heart diseases than for other cardiac conditions. The mortality associated with HF and its cause was also lower for children with congenital heart disease (4.7%) than for the other cardiac conditions (8.7%, 23.0%, and 25.0%, for acquired heart diseases, rhythm disturbances, and cardiomyopathies, respectively). Conclusion: Clear differences exist between HF in infants and HF in children. Our study supports the observation that congenital heart disease is the most common causative factor of HF during infancy. Older children with HF are more likely to have acquired heart diseases, cardiomyopathies, and arrhythmias, and these conditions have a considerable mortality.Key words: epidemiology, heart failure, congenital heart disease, arrhythmia, child IntroductionEpidemiological data from the Framingham Study provide insights into the population burden of heart failure (HF), its prognosis, and modifiable risk factors that promote it. In the general population, HF is chiefly the end stage of hypertensive, coronary, and valvular cardiovascular disease. 1 -3 Hypertension has the greatest impact, 4 accounting for 39% of HF events in men and 59% in women, followed by myocardial infarction (34% and 13% of HF events in men and women, respectively), and valvular heart disease (7%-8% of HF events).In contrast to the adult age group, HF in the pediatric population has received little attention. The aim of this prospective study was to analyze the epidemiology of HF during infancy and childhood.

Heart failure in children

“…reported that only 10% of their patients in a tertiary care pediatric cardiology care setting developed symptomatic HF. [4]…”

Heart Failure in Children

“…39 Two studies of heart failure in children, each covering 10 years, have been reported recently from European tertiary care facilities. 40,41 Children with heart failure represented 10% to 33% of all cardiac admissions. Slightly more than half of the pediatric heart failure cases reported in both studies were due to congenital heart disease, although the incidence of heart failure in children with congenital heart disease was only 6% to 24%.…”

Challenges of designing multicenter trials in pediatric heart failure

“…Increasingly, genetic abnormalities are being identified in pediatric cardiomyopathy patients that result in systolic and/or diastolic dysfunction [22]. In complex congenital heart disease, ventricular morphology is often abnormal in addition to systolic dysfunction and arrhythmias and cyanosis can contribute to the development or severity of heart failure [16,23,24]. There is some evidence to support disruption of the neurohumoral axis in pediatric heart failure due to systolic ventricular dysfunction, however in patients with structural heart disease the data is conflicting [25][26][27][28].…”