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Comorbidities, pharmacologic interventions, and mechanical interventions associated with mortality in isolated diastolic left heart failure: lessons from a national database

Published online by Cambridge University Press:  28 October 2024

Rohit S. Loomba Open the ORCID record for Rohit S. Loomba [Opens in a new window] ,
Nobuyuki Ikeda ,
Juan S Farias Open the ORCID record for Juan S Farias [Opens in a new window] ,
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, Oak Lawn, IL, USA Department of Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
Nobuyuki Ikeda
Affiliation:
Division of Cardiology, Advocate Children’s Hospital, Oak Lawn, IL, USA
Juan S Farias*
Affiliation:
Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO, 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
*
Corresponding author: Juan S. Farias; Email: [email protected]
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Abstract

Background:

Diastolic heart failure may be noted in paediatric patients with CHD, cardiomyopathy, or malignancies requiring chemotherapy, but the available data are scarce, and often derived from adult trials or based on theoretic or anecdotal evidence.

Methods:

Data between 2016 and 2021 were obtained from Pediatric Health Information System database. Patients <18 years of age with isolated diastolic heart failure admitted to ICU at some point during admission were included. They were divided into patients with and without inpatient mortality. Patients’ demographics, comorbidities using ICD-10 codes, and pharmacologic interventions were also recorded. Univariate analysis was done in demographics, comorbidities, pharmacologic interventions, and mechanical interventions between admissions with and without mortality. Multivariable logistic regression was done for inpatient mortality and multivariable linear regression was done for total hospital length of stay in survivors.

Results:

Isolated diastolic heart failure comprised 0.5% of critically ill paediatric patients. A total of 121 (5%) experienced mortality among the 2,273 admissions in the final analyses. Milrinone and angiotensin converting enzyme inhibitor were found to be associated with decreased mortality. Increasing age and diuretics were associated with decreased total hospital length of stay in survivors.

Conclusion:

In the cohort studied, isolated diastolic left heart failure has a 5% mortality. Several comorbidities and interventions are associated with increased mortality with milrinone and angiotensin converting enzyme inhibitors being associated with decreased risk of mortality. When only admissions with survival to discharge are considered, older age and diuretics are associated with lower total hospital length of stay.

Keywords

Diastolic heart failureCHDpaediatric ICUcardiovascular drugs
Type
Original Article
Information
Cardiology in the Young , Volume 35 , Issue 1 , January 2025 , pp. 102 - 108
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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