HRS: Cardiomyopathy in pediatrics linked to arrhythmias, costs

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SAN FRANCISCO—Cardiac arrhytmias were more prevelent in pediatric cardiomyopathy (PCM) patients compared to any other diagnosis, according to the results of a poster presentation May 4 at the annual Heart Rhythm Society (HRS) scientific sessions. These arrhythmias were linked to longer length of stays and higher costs.

While research outlining the prevalence and costs associated with cardiac arrhythmias in adult population is prevalent, these data are limited for the pediatric arrhythmia population. To bolster these data, Chandramouleeswaran Srinivasan, MD, and colleagues of the Baylor College of Medicine in Houston, conducted the largest study of its kind that evaluated inpatient PCM admissions data for 8,008 patients from 3,739.

“While we have always known the risk of death in cardiomyopathy patients, we have never outlined the risk in the pediatric population,” Srinivasan told Cardiovascular Business News.

Data was collected from the 2006 Healthcare Cost and Utilization Project (HCUP) Kids Inpatient Database, a U.S. database collecting information on pediatric hospital discharges.

During the study, Srinivasan and colleagues evaluated what impact cardiac arrhythmias had on length of stay, morbidity, mortality, inpatient costs and hospital stay.

Tachyarrhythmia was present in 9.2 percent of patients and bradyarrhythmia was present in 2.8 percent of patients. These two types of arrhythmias were more prevalent in pediatric patients with PCM compared to those without. The researchers also found that supraventricular tachycardia (SVT) and ventricular tachyarrhythmia (VT) were present in 4.2 percent and 6 percent of the study population.

Srinivasan noted that incidence of VT and BA was both associated with an increased length of hospital stay and heightened costs. Additionally, while only 6 percent of this pediatric population had VT costs were still significantly increased, Srinivasan said.

Hospital costs for VT and bradyarrhythmia were $54, 776 vs. $53, 594; these costs for patients without these arrhythmias were $33,855 vs. $34,566.

During a multivariate analysis, Srinivasan et al reported that while VT was an independent predictor of in-hospital death, SVT was not. The analysis controlled for comorbidities such as sepsis, acute renal failure, respiratory failure, stroke and seizure.

The researchers also noted that patients with PCM had a greater need for VAD support.

“These results definitely bring to light the magnitude of these arrhythmias,” Srinivasan said during an interview.

Srinivasan offered that future research from the center will focus on attempting to understand why these costs are so much higher for these pediatric patients with PCM and what the best management strategies for this population are.

In the meantime Srinivasan speculated these lofty costs could be linked to staffing costs and ICD placement and medication costs.

Additionally, Srinivasan said that currently there is not a clear consensus of how aggressively these types of arrhythmias should be managed. “We must ask how aggressively these arrhythmias should be managedm, do we use medication and do all of these patients need an ICD? “

“There is still no consensus so it’s important for us to know the impact of these types of management strategies and how to integrate them into practice,” Srinivasan concluded.