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Pediatric heart failure: current state and future possibilities.

Rossano JW, Jang GY - Korean Circ J (2015)

Bottom Line: The condition is associated with a high rate of morbidity and mortality and places a significant burden on families of affected children and to society as a whole.Current medical therapy is taken largely from the management of heart failure in adults, though clear survival benefit of these medications are lacking.There is an ongoing investigation to improve outcomes in high-risk populations, such as small infants and those with complex congenital heart disease, including patients with functionally univentricular hearts.

View Article: PubMed Central - PubMed

Affiliation: The Cardiac Center, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

ABSTRACT
Heart failure is a complex pathophysiological syndrome that can occur in children from a variety of diseases, including cardiomyopathies, myocarditis, and congenital heart disease. The condition is associated with a high rate of morbidity and mortality and places a significant burden on families of affected children and to society as a whole. Current medical therapy is taken largely from the management of heart failure in adults, though clear survival benefit of these medications are lacking. Ventricular assist devices (VADs) have taken an increasingly important role in the management of advanced heart failure in children. The predominant role of these devices has been as a bridge to heart transplantation, and excellent results are currently achieved for most children with cardiomyopathies. There is an ongoing investigation to improve outcomes in high-risk populations, such as small infants and those with complex congenital heart disease, including patients with functionally univentricular hearts. Additionally, there is an active investigation and interest in expansion of VADs beyond the predominant utilization as a bridge to a heart transplant into ventricular recovery, device explant without a heart transplantation (bridge to recovery), and placement of devices without the expectation of recovery or transplantation (destination therapy).

No MeSH data available.


Related in: MedlinePlus

Hospital mortality of children with heart failure related hospitalizations. *Significantly increased hospital mortality (p<0.05). HTN: hypertension, CVD: cerebrovascular disease, ECMO: extra corporeal membrane oxygenation, VAD: ventricular assist device. Adopted from Rossano JW, et al. with permission from the publisher.10)
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Figure 1: Hospital mortality of children with heart failure related hospitalizations. *Significantly increased hospital mortality (p<0.05). HTN: hypertension, CVD: cerebrovascular disease, ECMO: extra corporeal membrane oxygenation, VAD: ventricular assist device. Adopted from Rossano JW, et al. with permission from the publisher.10)

Mentions: Though the etiology of heart failure often differs from that of adults, children are not immune from the burden of heart failure. Massin et al.9) reviewed all cardiac admissions at a tertiary pediatric center in Belgium and found that heart failure occurred in 10% of patients, ranging from 6% of patients with congenital heart disease and 80% for cardiomyopathies. Hospital mortality ranged from 4.7% for children with congenital heart disease to 25.0% for cardiomyopathies. In the United States, there are roughly 14000 hospitalizations annually which approximates eighteen admissions per 100000 children.10) This ranks heart failure among the more common serious acute onset conditions of childhood.11) The majority of these children have some form of congenital heart disease, with about 15% having a cardiomyopathy or myocarditis. The disease carries a substantially increased risk of death with an over twentyfold increased risk of hospital mortality compared to pediatric patients without heart failure. Heart failure is a morbid condition in hospitalized patients with respiratory failure, renal failure, and sepsis occurring in a substantial minority of patients. Moreover, these morbidities are associated with a significant increase in the risk of death (Fig. 1). Additionally, these hospitalizations are lengthy, with the average length of stay being nearly twenty days in 2006, placing a substantial burden on families and society. The median hospital charges per admission were over $70000 in 2009 and this amount does not taken into account of the total cost of care beyond the hospitalization or other costs including missed work by parents.12)


Pediatric heart failure: current state and future possibilities.

Rossano JW, Jang GY - Korean Circ J (2015)

Hospital mortality of children with heart failure related hospitalizations. *Significantly increased hospital mortality (p<0.05). HTN: hypertension, CVD: cerebrovascular disease, ECMO: extra corporeal membrane oxygenation, VAD: ventricular assist device. Adopted from Rossano JW, et al. with permission from the publisher.10)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4310974&req=5

Figure 1: Hospital mortality of children with heart failure related hospitalizations. *Significantly increased hospital mortality (p<0.05). HTN: hypertension, CVD: cerebrovascular disease, ECMO: extra corporeal membrane oxygenation, VAD: ventricular assist device. Adopted from Rossano JW, et al. with permission from the publisher.10)
Mentions: Though the etiology of heart failure often differs from that of adults, children are not immune from the burden of heart failure. Massin et al.9) reviewed all cardiac admissions at a tertiary pediatric center in Belgium and found that heart failure occurred in 10% of patients, ranging from 6% of patients with congenital heart disease and 80% for cardiomyopathies. Hospital mortality ranged from 4.7% for children with congenital heart disease to 25.0% for cardiomyopathies. In the United States, there are roughly 14000 hospitalizations annually which approximates eighteen admissions per 100000 children.10) This ranks heart failure among the more common serious acute onset conditions of childhood.11) The majority of these children have some form of congenital heart disease, with about 15% having a cardiomyopathy or myocarditis. The disease carries a substantially increased risk of death with an over twentyfold increased risk of hospital mortality compared to pediatric patients without heart failure. Heart failure is a morbid condition in hospitalized patients with respiratory failure, renal failure, and sepsis occurring in a substantial minority of patients. Moreover, these morbidities are associated with a significant increase in the risk of death (Fig. 1). Additionally, these hospitalizations are lengthy, with the average length of stay being nearly twenty days in 2006, placing a substantial burden on families and society. The median hospital charges per admission were over $70000 in 2009 and this amount does not taken into account of the total cost of care beyond the hospitalization or other costs including missed work by parents.12)

Bottom Line: The condition is associated with a high rate of morbidity and mortality and places a significant burden on families of affected children and to society as a whole.Current medical therapy is taken largely from the management of heart failure in adults, though clear survival benefit of these medications are lacking.There is an ongoing investigation to improve outcomes in high-risk populations, such as small infants and those with complex congenital heart disease, including patients with functionally univentricular hearts.

View Article: PubMed Central - PubMed

Affiliation: The Cardiac Center, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.

ABSTRACT
Heart failure is a complex pathophysiological syndrome that can occur in children from a variety of diseases, including cardiomyopathies, myocarditis, and congenital heart disease. The condition is associated with a high rate of morbidity and mortality and places a significant burden on families of affected children and to society as a whole. Current medical therapy is taken largely from the management of heart failure in adults, though clear survival benefit of these medications are lacking. Ventricular assist devices (VADs) have taken an increasingly important role in the management of advanced heart failure in children. The predominant role of these devices has been as a bridge to heart transplantation, and excellent results are currently achieved for most children with cardiomyopathies. There is an ongoing investigation to improve outcomes in high-risk populations, such as small infants and those with complex congenital heart disease, including patients with functionally univentricular hearts. Additionally, there is an active investigation and interest in expansion of VADs beyond the predominant utilization as a bridge to a heart transplant into ventricular recovery, device explant without a heart transplantation (bridge to recovery), and placement of devices without the expectation of recovery or transplantation (destination therapy).

No MeSH data available.


Related in: MedlinePlus