The Lillie Frank Abercrombie Section of Cardiology, Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA.
Miller School of Medicine, University of Miami, Miami, Florida, USA.
J Cardiovasc Electrophysiol. 2022 Mar;33(3):502-509. doi: 10.1111/jce.15347. Epub 2022 Jan 7.
As pediatric implantable cardioverter-defibrillator (ICD) utilization increases, hospital admission rates will increase. Data regarding hospitalizations among pediatric patients with ICDs are lacking. In addition, hospital mortality rates are unknown. This study aimed to evaluate (1) trends in hospitalization rates from 2000 to 2016, (2) hospital mortality, and (3) factors associated with hospital mortality among pediatric admissions with ICDs.
The Kids' Inpatient Database (2000, 2003, 2006, 2009, 2012, 2016) was used to identify all hospitalizations with an existing ICD ≤20 years of age. ICD9/10 codes were used to stratify admissions by underlying diagnostic category as: (1) congenital heart disease (CHD), (2) primary arrhythmia, (3) primary cardiomyopathy, or (4) other. Trends were analyzed using linear regression. Hospital and patient characteristics among hospital deaths were compared to those surviving to discharge using mixed multivariable logistic regression, accounting for hospital clustering.
Of 42 570 716 hospitalizations, 4165 were admitted ≤20 years with an ICD. ICD hospitalizations increased four-fold (p = .002) between 2000 and 2016. Hospital death occurred in 54 (1.3%). In multivariable analysis, cardiomyopathy (odds ratio [OR]: 3.5, 95% confidence interval [CI]: 1.1-11.2, p = .04) and CHD (OR: 4.8, 95% CI: 1.5-15.6, p = .01) were significantly associated with mortality. In further exploratory multivariable analysis incorporating a coexisting diagnosis of heart failure, only the presence of heart failure remained associated with mortality (OR: 8.6, 95% CI: 3.7-20.0, p < .0001).
Pediatric ICD hospitalizations are increasing over time and hospital mortality is low (1.3%). Hospital mortality is associated with cardiomyopathy or CHD; however, the underlying driver for in-hospital death may be heart failure.
随着小儿植入式心脏复律除颤器（ICD）的应用增加，住院率也将增加。目前缺乏小儿患者 ICD 住院的数据。此外，医院死亡率也不清楚。本研究旨在评估：（1）2000 年至 2016 年住院率的趋势；（2）医院死亡率；（3）小儿 ICD 住院患者医院死亡率相关因素。
利用 Kids' Inpatient Database（2000、2003、2006、2009、2012、2016）确定所有 20 岁以下患有 ICD 的住院患者。使用 ICD9/10 代码对患者进行分类，根据潜在诊断类别分层：（1）先天性心脏病（CHD）；（2）原发性心律失常；（3）原发性心肌病；（4）其他。采用线性回归分析趋势。使用混合多变量逻辑回归比较医院死亡患者与存活至出院患者的医院和患者特征，同时考虑医院聚类。
在 42570716 例住院患者中，4165 例患者在 20 岁以下植入 ICD。2000 年至 2016 年期间，ICD 住院患者数量增加了四倍（p=0.002）。54 例患者死亡（1.3%）。多变量分析显示，心肌病（比值比[OR]：3.5，95%置信区间[CI]：1.1-11.2，p=0.04）和 CHD（OR：4.8，95%CI：1.5-15.6，p=0.01）与死亡率显著相关。在进一步的多变量分析中纳入心力衰竭的并存诊断时，只有心力衰竭的存在与死亡率相关（OR：8.6，95%CI：3.7-20.0，p<0.0001）。
小儿 ICD 住院患者数量随时间增加，死亡率较低（1.3%）。医院死亡率与心肌病或 CHD 相关；然而，院内死亡的根本驱动因素可能是心力衰竭。
