Pediatric Versus Adult Cardiomyopathy and Heart Failure–Related Hospitalizations: A Value-Based Analysis

Wittlieb-Weber, Carol A.; Lin, Kimberly Y.; Zaoutis, Theoklis E.; O’Connor, Matthew J.; Gerald, Ken; Paridon, Stephen M.; Shaddy, Robert E.; Rossano, Joseph W.

doi:10.1016/j.cardfail.2014.10.011

Cited by 46 publications

(20 citation statements)

References 15 publications

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“…Most heart failure admissions, even without VAD placement, are prolonged and associated with high resource utilization, morbidity, and mortality . In a study of adult and pediatric cardiomyopathy patients admitted with heart failure, the pediatric patients had an average LOS of 16 days and average hospital charges of $116 000 compared to adults who averaged a LOS of 7 days and charges of $40 000 . Additionally, mortality and morbidities such as respiratory failure and sepsis were also greater in children as compared to adults .…”

Section: Discussionmentioning

confidence: 99%

Resource Utilization in Pediatric Patients Supported With Ventricular Assist Devices in the United States: A Multicenter Study From the Pediatric Interagency Registry for Mechanically Assisted Circulatory Support and the Pediatric Health Information System

Rossano

Cantor

Dai

et al. 2018

JAHA

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BackgroundFew data exist on resource utilization with pediatric ventricular assist devices (VADs). We tested the hypothesis that device type and adverse events are associated with increased resource utilization in pediatric patients supported with VADs.Methods and ResultsThe Pediatric Interagency Registry for Mechanically Assisted Circulatory Support, a national registry of VADs in patients <19 years old, and the Pediatric Health Information System, an administrative database, were merged. Univariate analysis was performed assessing the association of all factors with the total cost and length of stay first. Significant variables (P<0.05) were subjected to multivariable analysis. The study included 142 patients from 19 centers with VAD implants from October 2012 to June 2016. The median age was 9 years (interquartile range [IQR] 2‐15), 84 (59%) supported with a continuous‐flow VAD. Overall median hospital costs were $750 000 (IQR $539 000 to $1 100 000) with a median hospital length of stay of 81 days (IQR 54‐128). On multivariable analysis, device type and postoperative complications were not associated with resource utilization. Factors associated with increased costs included patient age, lower‐volume VAD center, being intubated, being on extracorporeal membrane oxygenation, number of complex chronic medical conditions, and length of stay. Among continuous‐flow VAD patients, discharge to home before transplant versus remaining hospitalized was associated with lower hospital costs (median $600 000 [IQR $400 000 to $820 000] versus median $680 000 [IQR $500 000 to $970 000], P=0.03).Conclusion VADs in pediatric patients are associated with high resource utilization. Increased resource utilization was associated with lower‐volume VAD centers, disease severity at VAD implantation, and the presence of complex chronic medical conditions. Further study is needed to develop cost‐effective strategies in this complex population.

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Section: Discussionmentioning

confidence: 99%

Resource Utilization in Pediatric Patients Supported With Ventricular Assist Devices in the United States: A Multicenter Study From the Pediatric Interagency Registry for Mechanically Assisted Circulatory Support and the Pediatric Health Information System

Rossano

Cantor

Dai

et al. 2018

JAHA

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“…98 Compared to adults, children with cardiomyopathy hospitalized with heart failure had greater morbidity and mortality and utilized advanced heart failure therapies more frequently. 99 In patients with DCM as a component of a multisystem disease (e.g., neuromuscular, metabolic, and mitochondrial disorders) the underlying disease is often an important determinant of patient outcome. 1, 3, 15 …”

Section: Dilated Cardiomyopathymentioning

confidence: 99%

Pediatric Cardiomyopathies

Lee

Hsu

Kantor

et al. 2017

Circulation Research

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Pediatric cardiomyopathies are rare diseases with an annual incidence of 1.1–1.5 per 100,000. Dilated and hypertrophic cardiomyopathies are the most common; restrictive, noncompaction, and mixed cardiomyopathies occur infrequently; and arrhythmogenic right ventricular cardiomyopathy is rare. Pediatric cardiomyopathies can result from coronary artery abnormalities, tachyarrhythmias, exposure to infection or toxins, or secondary to other underlying disorders. Increasingly, the importance of genetic mutations in the pathogenesis of isolated or syndromic pediatric cardiomyopathies is becoming apparent. Pediatric cardiomyopathies often occur in the absence of co-morbidities such as atherosclerosis, hypertension, renal dysfunction, and diabetes; as a result, they offer insights into the primary pathogenesis of myocardial dysfunction. Large international registries have characterized the epidemiology, etiology, and outcomes of pediatric cardiomyopathies. Although adult and pediatric cardiomyopathies have similar morphologic and clinical manifestations, their outcomes differ significantly. Within two years of presentation, normalization of function occurs in 20% of children with dilated cardiomyopathy, and 40% die or undergo transplantation. Infants with hypertrophic cardiomyopathy have a two-year mortality of 30%, whereas death is rare in older children. Sudden death is rare. Molecular evidence indicates that gene expression differs between adult and pediatric cardiomyopathies, suggesting treatment response may differ as well. Clinical trials to support evidence-based treatments and the development of disease-specific therapies for pediatric cardiomyopathies are in their infancy. This compendium summarizes current knowledge of the genetic and molecular origins, clinical course, and outcomes of the most common phenotypic presentations of pediatric cardiomyopathies, and highlights key areas where additional research is required.

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“…However, there have been significant improvements in the care of patients with heart failure with recent data demonstrating an improvement in hospital and overall survival ( Fig. 1) [3,8]. While survival has improved, morbidity and costs remain high and not clearly improving.…”

Section: Introductionmentioning

confidence: 97%

“…While survival has improved, morbidity and costs remain high and not clearly improving. Importantly, the hospital length of stay and hospital charges for children hospitalized with heart failure are increasing and at a rate greater than seen among adults [3]. This is an exciting time for the field of pediatric heart failure.…”

Section: Introductionmentioning

confidence: 99%

“…The onset of heart failure leads to a significant increase in morbidity and mortality in patients with congenital and acquired heart disease [1][2][3][4][5]. The risk of hospital mortality in children hospitalized with heart failure is over 20-fold compared to hospitalized children without heart failure and the overall transplant free survival for patients diagnosed with dilated cardiomyopathy is approximately 50% at 5 years [4,6,7].…”

Section: Introductionmentioning

confidence: 99%

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