Hostname: page-component-848d4c4894-4hhp2 Total loading time: 0 Render date: 2024-05-27T21:36:26.530Z Has data issue: false hasContentIssue false
  • English
  • Français

The impact of medical interventions on admission characteristics in children with congenital heart disease and cardiomyopathy

Published online by Cambridge University Press:  16 December 2020

Rohit S. Loomba Open the ORCID record for Rohit S. Loomba [Opens in a new window] ,
Jacqueline Rausa ,
Vincent Dorsey ,
Ronald A. Bronicki ,
Enrique G. Villarreal Open the ORCID record for Enrique G. Villarreal [Opens in a new window]  and
Saul Flores Open the ORCID record for Saul Flores [Opens in a new window]
Rohit S. Loomba
Affiliation:
Division of Cardiology, Advocate Children’s Hospital, Chicago, IL, USA Department of Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
Jacqueline Rausa
Affiliation:
Division of Cardiology, Advocate Children’s Hospital, Chicago, IL, USA
Vincent Dorsey
Affiliation:
Division of Cardiology, Advocate Children’s Hospital, Chicago, IL, USA
Ronald A. Bronicki
Affiliation:
Section of Critical Care Medicine and Cardiology, Texas Children’s Hospital, Houston, TX, USA Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Enrique G. Villarreal*
Affiliation:
Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
Saul Flores
Affiliation:
Section of Critical Care Medicine and Cardiology, Texas Children’s Hospital, Houston, TX, USA Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
*
Author for correspondence: E. G. Villarreal, MD, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico. Tel: +(811) 324-4817. E-mail: quique_villarreal93@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Children with congenital heart disease and cardiomyopathy are a unique patient population. Different therapies continue to be introduced with large practice variability and questionable outcomes. The purpose of this study is to determine the impact of various medications on intensive care unit length of stay, total length of stay, billed charges, and mortality for admissions with congenital heart disease and cardiomyopathy.

Materials and methods:

We identified admissions of paediatric patients with cardiomyopathy using the Pediatric Health Information System database. The admissions were then separated into two groups: those with and without inpatient mortality. Univariate analyses were conducted between the groups and the significant variables were entered as independent variables into the regression analyses.

Results:

A total of 10,376 admissions were included these analyses. Of these, 904 (8.7%) experienced mortality. Comparing patients who experienced mortality with those who did not, there was increased rate of acute kidney injury with an odds ratio (OR) of 5.0 [95% confidence interval (CI) 4.3 to 5.8, p < 0.01], cardiac arrest with an OR 7.5 (95% CI 6.3 to 9.0, p < 0.01), and heart transplant with an OR 0.3 (95% CI 0.2 to 0.4, p < 0.01). The medical interventions with benefit for all endpoints after multivariate regression analyses in this cohort are methylprednisolone, captopril, enalapril, furosemide, and amlodipine.

Conclusions:

Diuretics, steroids, angiotensin-converting enzyme inhibitors, calcium channel blockers, and beta blockers all appear to offer beneficial effects in paediatric cardiomyopathy admission outcomes. Specific agents within each group have varying effects.

Keywords

cardiomyopathycongenital heart defectmortality ratepaediatricshospital cost
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 3 , March 2021 , pp. 406 - 413
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Lipshultz, SE. Ventricular dysfunction clinical research in infants, children and adolescents. Prog Pediatr Cardiol 2000; 12: 1–28.CrossRefGoogle ScholarPubMed
Vaidyanathan, B. Is there a role for carvedilol in the management of pediatric heart failure? A meta analysis and e-mail survey of expert opinion. Ann Pediatr Cardiol 2009; 2: 74–78.CrossRefGoogle Scholar
Heying, R, Wehage, E, Schumacher, K, et al. Dexamethasone pretreatment provides antiinflammatory and myocardial protection in neonatal arterial switch operation. Ann Thorac Surg 2012; 93: 869–876.CrossRefGoogle ScholarPubMed
Roche, SL, Timberlake, K, Manlhiot, C, et al. Angiotensin-converting enzyme inhibitor initiation and dose uptitration in children with cardiovascular disease: a retrospective review of standard clinical practice and a prospective randomized clinical trial. J Am Heart Assoc 2016; 5: e003230.CrossRefGoogle Scholar
Lewis, AB, Chabot, M. The effect of treatment with angiotensin-converting enzyme inhibitors on survival of pediatric patients with dilated cardiomyopathy. Pediatr Cardiol 1993; 14: 9–12.Google ScholarPubMed
van Smeden, MdG, de Groot, JAH, Moons, KGM, et al. No rationale for 1 variable per 10 events criterion for binary logistic regression analysis. BMC Med Res Methodol 2016; 16: 163.CrossRefGoogle ScholarPubMed
Vittinghoff, E, McCulloch, CE. Relaxing the rule of ten events per variable in logistic and Cox regression. Am J Epidemiol 2007; 165: 710–718.CrossRefGoogle ScholarPubMed
Austin, PC, Steyerberg, EW. The number of subjects per variable required in linear regression analyses. J Clin Epidemiol 2015; 68: 627–636.CrossRefGoogle ScholarPubMed
Alkhateeb, M, Alsakkal, M, Alfauri, MN, Alasmar, D. Reversible dilated cardiomyopathy as a complication of adrenal cortex insufficiency: a case report. J Med Case Rep 2018; 12: 345.CrossRefGoogle ScholarPubMed
Odek, C, Kendirli, T, Kocaay, P, et al. Acute reversible cardiomyopathy and heart failure in a child with acute adrenal crisis. Paediatr Int Child Health 2017; 37: 148–151.CrossRefGoogle Scholar
Alqahtani, MA, Shati, AA, Zou, M, et al. A novel mutation in the CYP11B1 gene causes steroid 11beta-Hydroxylase deficient congenital adrenal hyperplasia with reversible cardiomyopathy. Int J Endocrinol 2015; 2015: 595164.CrossRefGoogle ScholarPubMed
Hauser, J, Riedl, S, Michel-Behnke, I, Minkov, M, Perneczky, E, Horcher, E. Hypertrophic obstructive cardiomyopathy in an infant with an adrenocortical tumor. Pediatrics 2013; 132: e535–e539.CrossRefGoogle Scholar
Al Jarallah, AS. Reversible cardiomyopathy caused by an uncommon form of congenital adrenal hyperplasia. Pediatr Cardiol 2004; 25: 675–676.CrossRefGoogle ScholarPubMed
Barber, BJ, Andrews, JG, Lu, Z, et al. Oral corticosteroids and onset of cardiomyopathy in Duchenne muscular dystrophy. J Pediatr 2013; 163: 1080–1084 e1081.CrossRefGoogle ScholarPubMed
Harmon, WG, Sleeper, LA, Cuniberti, L, et al. Treating children with idiopathic dilated cardiomyopathy (from the Pediatric Cardiomyopathy Registry). Am J Cardiol 2009; 104: 281–286.CrossRefGoogle Scholar
Kantor, PF, Abraham, JR, Dipchand, AI, Benson, LN, Redington, AN. The impact of changing medical therapy on transplantation-free survival in pediatric dilated cardiomyopathy. J Am Coll Cardiol 2010; 55: 1377–1384.CrossRefGoogle ScholarPubMed
Yuan, Y, Meng, L, Zhou, Y, Lu, N. Genetic polymorphism of angiotensin-converting enzyme and hypertrophic cardiomyopathy risk: a systematic review and meta-analysis. Medicine (Baltimore) 2017; 96: e8639.CrossRefGoogle ScholarPubMed
Momma, K. ACE inhibitors in pediatric patients with heart failure. Paediatr Drugs 2006; 8: 55–69.CrossRefGoogle ScholarPubMed
Parent, JJ, Towbin, JA, Jefferies, JL. Medical therapy leads to favorable remodeling in left ventricular non-compaction cardiomyopathy: dilated phenotype. Pediatr Cardiol 2016; 37: 674–677.CrossRefGoogle ScholarPubMed
Allen, HD, Flanigan, KM, Thrush, PT, et al. A randomized, double-blind trial of lisinopril and losartan for the treatment of cardiomyopathy in duchenne muscular dystrophy. PLoS Curr 2013; 5: ecurrents.md.2cc69a1dae4be7dfe2bcb420024ea865.Google Scholar
Spicer, RL, Rocchini, AP, Crowley, DC, Rosenthal, A. Chronic verapamil therapy in pediatric and young adult patients with hypertrophic cardiomyopathy. Am J Cardiol 1984; 53: 1614–1619.CrossRefGoogle Scholar
Shaffer, EM, Rocchini, AP, Spicer, RL, et al. Effects of verapamil on left ventricular diastolic filling in children with hypertrophic cardiomyopathy. Am J Cardiol 1988; 61: 413–417.CrossRefGoogle ScholarPubMed
Pacileo, G, De Cristofaro, M, Russo, MG, Sarubbi, B, Pisacane, C, Calabro, R. Hypertrophic cardiomyopathy in pediatric patients: effect of verapamil on regional and global left ventricular diastolic function. Can J Cardiol 2000; 16: 146–152.Google ScholarPubMed
Ostman-Smith, I. Beta-blockers in pediatric hypertrophic cardiomyopathies. Rev Recent Clin Trials 2014; 9: 82–85.CrossRefGoogle ScholarPubMed
Oflaz, MB, Balli, S, Kibar, AE, Ece, I, Akdeniz, C, Tuzcu, V. Effects of carvedilol therapy on cardiac autonomic control, QT dispersion, and ventricular arrhythmias in children with dilated cardiomyopathy. Med Sci Monit 2013; 19: 366–372.Google ScholarPubMed
Saxena, A, Anil, OM, Juneja, R. Clinical and echocardiographic outcome in patients receiving carvedilol for treatment of dilated cardiomyopathy. Indian J Pediatr 2013; 80: 549–554.CrossRefGoogle ScholarPubMed
Huang, M, Zhang, X, Chen, S, et al. The effect of carvedilol treatment on chronic heart failure in pediatric patients with dilated cardiomyopathy: a prospective, randomized-controlled study. Pediatr Cardiol 2013; 34: 680–685.CrossRefGoogle ScholarPubMed
Erdogan, I, Ozer, S, Karagoz, T, Celiker, A, Ozkutlu, S, Alehan, D. Treatment of dilated cardiomyopathy with carvedilol in children. Turk J Pediatr 2009; 51: 354–360.Google ScholarPubMed
Askari, H, Semizel, E, Bostan, OM, Cil, E. Carvedilol therapy in pediatric patients with dilated cardiomyopathy. Turk J Pediatr 2009; 51: 22–27.Google ScholarPubMed
Rusconi, P, Gomez-Marin, O, Rossique-Gonzalez, M, et al. Carvedilol in children with cardiomyopathy: 3-year experience at a single institution. J Heart Lung Transplant 2004; 23: 832–838.CrossRefGoogle ScholarPubMed
Gachara, N, Prabhakaran, S, Srinivas, S, Farzana, F, Krishnan, U, Shah, MJ. Efficacy and safety of carvedilol in infants with dilated cardiomyopathy: a preliminary report. Indian Heart J 2001; 53: 74–78.Google ScholarPubMed
Supplementary material: File

Loomba et al. supplementary material

Loomba et al. supplementary material

Download Loomba et al. supplementary material(File)
File 23 KB