The Public Health Burden of Cardiomyopathies: Insights from a Nationwide Inpatient Study

Abstract

Cardiomyopathies are responsible for heart failure and sudden cardiac death, but epidemiological data are scarce and the public health burden may be underestimated. We studied aggregating data from all public or private hospitals in France. Patients were categorized from relevant ICD-10 codes into dilated, hypertrophic, restrictive, or other cardiomyopathies (DCM, HCM, RCM, or OCM, respectively). Between 2008 and 2015, a total of 326,461 distinct patients had cardiomyopathy-related hospitalizations. The hospital-based prevalence of cardiomyopathy was 809 per million inhabitants (PMI) per year, including 428 PMI for DCM, 101 PMI for HCM, 26 PMI for RCM, and 253 PMI for OCM. Patients with cardiomyopathies accounted for 51% of all heart transplants, 33% of defibrillator implantations, 38% of mechanical circulatory supports, and 11.3% of hospitalizations for heart failure. In patients less than 40 years of age, these figures were 71%, 51%, 63%, and 23%, respectively. Over 2008–2015 and considering all cardiomyopathies, there was a significant increase for heart transplant (average annual percentage change, AAPC: +3.86%, p = 0.0015) and for defibrillator implantation (AAPC: +6.98%, p < 0.0001), and a significant decrease of in-hospital mortality (AAPC: −4.7%, p = 0.0002). This nationwide study shows that cardiomyopathies constitute an important cause of hospitalization, with increasing invasive therapeutic procedures and decreasing mortality.

Leveraging Clinical Informatics Tools to Extract Cumulative Anthracycline Exposure, Measure Cardiovascular Outcomes, and Assess Guideline Adherence for Children With Cancer

“…Longitudinal, interinstitutional collaborations that leverage structured data elements and interoperability within pediatric oncology will be increasingly important as new agents with potential cardiotoxicity change the landscape of survivorship care in the future. 59,60 33 Allen et al, 35 and Khera et al 34…”

“…The application of established ICD-9-CM and ICD-10-CM coding schema for heart failure [33][34][35] illustrates the opportunity to capture early CVD for children with cancer. The use of dexrazoxane for cardioprotection may account for the lack of significant difference in cardiac events between the low and high anthracycline groups; however, this may also reflect insufficient power because of the small sample size.…”

“…Established classifications for cardiomyopathy, heart failure, atrial fibrillation, and ventricular arrhythmias provided a framework to capture major cardiac outcomes during the treatment and early survivorship periods (Appendix Table A1). [33][34][35][36] Anthracycline Exposure Discrete data elements for cumulative anthracycline exposure were extracted through SQL coding from the Epic EHR reporting database Clarity. The lifetime dose-tracking table, built into Epic by the informatics team at Duke, captures the total cumulative dose for each type of anthracycline, measured in milligrams per meter squared.…”

Usefulness of Longitudinal Strain Adjusted to Regional Thickness in Hypertrophic Cardiomyopathy

“…Cardiomyopathies are usually divided into four main subtypes [1]: hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy, with other non-classified subtypes. Hypertrophic cardiomyopathy (HCM) is a heart disease defined by the presence of increased left ventricular (LV) wall thickness without abnormal loading conditions (hypertension, aortic stenosis) [1][2][3][4]. Its prevalence ranges from 0.02% to 0.23% [1].…”

“…New imaging techniques, such as myocardial deformation, have been developed for the assessment of LV function. In HCM, longitudinal strain analysis allows us to detect early LV contraction abnormalities despite obvious preserved LV ejection fractions [4,9], and some studies suggest a prognostic interest in cardiovascular risk stratification in these patients [10,11].…”