Trends in Hospitalization for Pediatric Pulmonary Hypertension

Abstract

BACKGROUND AND OBJECTIVES: Pulmonary hypertension (PH) has been associated with substantial morbidity and mortality in children, but existing analyses of inpatient care are limited to small single-institution series or focused registries representative of selected patient subgroups. We examined US national data on pediatric PH hospitalizations to determine trends in volume, demographics, procedures performed during admission, and resource utilization.

Executive Summary of the American Heart Association and American Thoracic Society Joint Guidelines for Pediatric Pulmonary Hypertension

“…Despite advances in our understanding of its pathobiology and the growing availability of drug therapies, PH-related morbidity and mortality remain high. More recently, PH-related hospitalizations and resource use for the care of children with PVD have increased, likely reflecting growing recognition of the relevance of PH in diverse clinical settings or perhaps an actual increase in the incidence of disease (4). Although similarities exist regarding disease etiology and pathophysiology of some forms of pediatric and adult PH, many cardiopulmonary and systemic diseases associated with PH are unique to neonates, infants, and children (2,3,5).…”

Executive summary. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK

“…Despite significant advances in pulmonary arterial hypertension (PAH)-targeted therapies, survival of children and adults with idiopathic PAH and other forms of group 1 pulmonary hypertension (PH), such as persistent PAH after repair of congenital heart disease (CHD), remains poor 7–12. Morbidity and mortality of paediatric PH represent substantial and growing healthcare burden:12–15 From 1997 to 2012, shifts in case mix toward paediatric PH not associated with CHD, non-cardiac procedures and care in urban teaching hospitals have been noted in a recent retrospective study in the USA 15. Based on a separate analysis of the period 2000–2009, the number of PH-related hospitalizations of children is increasing, and the overall mortality for PH-related hospitalizations is greater than that for hospitalizations not associated with PH (5.7% vs 0.4%; odds ratio: 16.22 (95% CI 14.8% to 17.8%), p<0.001) 16.…”

Hospitalizations of Children With Pulmonary Hypertension: Implications for Improving Care

“…As noted by the authors, 4 a potential limitation of the study is the questionable reliability of diagnostic billing codes from the Kids' Inpatient Database to accurately reflect the true frequency of PH-related hospitalizations and related costs. However, this important report will likely stimulate and be followed by more in-depth work.…”

“…4 As previously noted, developing strong interdisciplinary PH care programs at experienced centers and collaborations among these centers will foster high-quality research, standardize diagnostic and treatment strategies, and enhance the development and application of care guidelines. 3 As best demonstrated by the marked success of the Cystic Fibrosis Foundation in improving outcomes for subjects with this disease, the need for developing clinical and research networks by using similar approaches may translate into substantial gains for families and children with PH.…”

“…In this issue of Pediatrics, Maxwell et al 4 provide important new information that examines national trends in hospitalizations and resource utilization as obtained from a national database. The authors report significant rates of hospitalization that have been increasing over the past decade and are associated with rising hospital costs.…”