Individual Risk Factors and Complexity Associated with Congenital Heart Disease in a Pediatric Medicaid Cohort

Shuler, C. Osborne; Tripathi, Avnish; Black, George B.; Park, Young Jun; Jerrell, Jeanette M.

doi:10.1097/smj.0b013e31829bd0bc

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…Second, given the similarity of results using the categorized and continuous BMI measures, we chose to use the categorized measure to facilitate interpretation of the associated PAF estimate by focusing on the impact of modifying the number of women whose prepregnancy BMI would put them in the overweight–obese category. We included nonmodifiable risk factors (male sex [57–59], nonHispanic White race [60–62], and family history of a first-degree relative with CHD [27,28]) in the model to estimate the proportion of HLHS attributable to the full set of recognized risk factors. Although not included as a risk factor in the final model, maternal smoking in B1-P3 was also included as a potential confounder.…”

Section: Methodsmentioning

confidence: 99%

Proportion of selected congenital heart defects attributable to recognized risk factors

Simeone

Tinker

Gilboa

et al. 2016

Annals of Epidemiology

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Purpose To assess the contribution of multiple risk factors for two congenital heart defects—hypoplastic left heart syndrome (HLHS) and tetralogy of Fallot (TOF). Methods We used data from the National Birth Defects Prevention Study (1997–2011) to estimate average adjusted population attributable fractions for several recognized risk factors, including maternal prepregnancy overweight–obesity, pregestational diabetes, age, and infant sex. Results There were 594 cases of isolated simple HLHS, 971 cases of isolated simple TOF, and 11,829 controls in the analysis. Overall, 57.0% of HLHS cases and 37.0% of TOF cases were estimated to be attributable to risk factors included in our model. Among modifiable HLHS risk factors, maternal pre-pregnancy overweight–obesity accounted for the largest proportion of cases (6.5%). Among modifiable TOF risk factors, maternal prepregnancy overweight–obesity and maternal age of 35 years or older accounted for the largest proportions of cases (8.3% and 4.3%, respectively). Conclusions Approximately half of HLHS cases and one-third of TOF cases were estimated to be attributable to risk factors included in our models. Interventions targeting factors that can be modified may help reduce the risk of HLHS and TOF development. Additional research into the etiology of HLHS and TOF may reveal other modifiable risk factors that might contribute to primary prevention efforts.

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Section: Methodsmentioning

confidence: 99%

Proportion of selected congenital heart defects attributable to recognized risk factors

Simeone

Tinker

Gilboa

et al. 2016

Annals of Epidemiology

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“…Previous studies reported that male gender was inconclusive as a predictor of HF in children. [24][25][26][27] In addition, another study reported that age grouping of 1-10 years was associated with HF and mortality in CHD. 28 Our subjects may have suffered HF for a long time before admission or had already taken anti-congestive drugs.…”

Section: Discussionmentioning

confidence: 99%

Predictors of heart failure in children with congenital heart disease

Nora¹,

Murni²,

Nugroho³

et al. 2022

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Background Heart failure continues to be a significant contributor to morbidity and mortality in children with congenital heart disease (CHD). Little is known about heart failure in children. Identifying predictors of heart failure in children with CHD can serve to guide preventive strategies to heart failure. Objective To understand the predictors of heart failure of children with congenital heart disease. Methods A nested, case-control study was performed using secondary data based on a prospective study previously conducted in Dr Sardjito Tertiary Hospital in Yogyakarta in years 2011-2013. We included children aged 1 month-18 years who had been diagnosed with CHD by echocardiography. Age, sex, type of CHD, CHD complexity, as well as presence of syndrome, no pulmonary obstruction, pneumonia, and malnutrition were analyzed as potential predictors of heart failure. Results are presented as odds ratios (OR) with 95% confidence intervals (95%CI). Results A total of 2,646 children were hospitalized in Dr Sardjito Tertiary Hospital during the study period. Congenital heart disease was noted in 216 children (8.16%), 200 (7.5%) of whom met the inclusion criteria. The 100 children with heart failure had median age of 1.5 years and 15% died during hospitalization. Multivariate analysis revealed that acyanotic CHD (OR 2.69; 95%CI 1.45 to 5.00), no pulmonary obstruction (OR 3.05; 95%CI 1.33 to 6.99) and the presence of pneumonia (OR 2.04; 95%CI 1.03 to 4.06) were statistically significant as independent predictors of heart failure in children with CHD. However, sex, age, CHD complexity, as well as presence of a syndrome, and malnutrition were not significantly associated with heart failure in children with CHD. Conclusion The predictors of heart failure in children with CHD were acyanotic CHD, no pulmonary obstruction, and presence of pneumonia.

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“…The severity of cardiac and non‐cardiac pathology amongst infants born with CHD varies widely, requiring a diverse range of surgical procedures . The Aristotle Comprehensive Complexity (ACC) score offers a means of measuring the complexity of congenital heart surgery procedures .…”

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confidence: 99%

Clinical feasibility of pre‐operative neurodevelopmental assessment of infants undergoing open heart surgery

Campbell

Rabbidge

Ziviani

et al. 2017

J Paediatrics Child Health

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Over half of the infants undergoing open heart surgery were unable to complete pre-operative neurodevelopmental assessment. The primary reason for this was infant-related medical instability. Findings suggest further research is warranted to investigate whether the Aristotle Patient-Adjusted Complexity score might serve as an indicator to inform developmental surveillance with this medically fragile cohort.

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Individual Risk Factors and Complexity Associated with Congenital Heart Disease in a Pediatric Medicaid Cohort

Abstract: 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.

Cited by 4 publications

References 9 publications

Proportion of selected congenital heart defects attributable to recognized risk factors

Proportion of selected congenital heart defects attributable to recognized risk factors

Predictors of heart failure in children with congenital heart disease

Clinical feasibility of pre‐operative neurodevelopmental assessment of infants undergoing open heart surgery

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