Cardiomyopathy
Usefulness of Arrhythmias as Predictors of Death and Resource Utilization in Children With Myocarditis

https://doi.org/10.1016/j.amjcard.2014.07.074Get rights and content

Highlights

  • We studied the effects of arrhythmias in children admitted with myocarditis.

  • The PHIS database was used.

  • Tachyarrhythmia was associated with a 2.3 times increase in the odds of mortality.

  • Tachyarrhythmia was associated with a 58% increase in length of stay.

  • Tachyarrhythmia was associated with a 28% increase in cost per day.

Myocarditis in children can result in significant morbidity and mortality, yet limited prognostic data exist. The aim of this study was to test the hypothesis that pediatric patients with arrhythmias during hospitalization for acute myocarditis have worse outcomes and increased resource utilization. A retrospective study using the Pediatric Health Information System database was performed to examine the effects of clinically significant arrhythmias on in-hospital mortality, length of stay, and costs per day. Data were obtained for children ≤18 years of age, discharged from January 1, 2004 to March 31, 2013, with a diagnosis of myocarditis. Clinically significant tachyarrhythmia was defined as supraventricular tachycardia, atrial fibrillation or flutter, or ventricular tachycardia or fibrillation in patients receiving antiarrhythmic medications or cardioversion. Clinically significant bradyarrhythmia was defined as second-degree, complete, or other heart block for which a pacemaker was placed. Multivariable analyses were performed. A total of 2,041 subjects with myocarditis were identified. Tachyarrhythmias were reported in 234 (11.5%) and bradyarrhythmias in 22 (1.1%). Overall mortality was 8.7%. In multivariable analyses, after considering the effects of gender, age at admission, geographic region, year and month of admission, presence of congenital heart disease or an identified virus, and use of steroids, nonsteroidal anti-inflammatories, or inotropes, and after controlling for clustering by institution, tachyarrhythmias were associated with a 2.3 times increase in the odds of mortality (95% confidence interval 1.6 to 3.3, p < 0.001), a 58% increase in length of stay (95% confidence interval 38% to 82%, p < 0.001), and a 28% increase in costs per day (95% confidence interval 15% to 43%, p < 0.001). Bradyarrhythmia was not associated with mortality, length of stay, or costs per day. In conclusion, tachyarrhythmias are associated with significant increases in mortality and resource utilization in children with myocarditis.

Section snippets

Methods

A retrospective cohort study was performed, using the Pediatric Health Information System (PHIS) database, to determine if the presence of arrhythmias was associated with in-hospital mortality, length of stay, and costs per day for children admitted with acute myocarditis. This study was classified by the Columbia University Medical Center Institutional Review Board as nonhuman subjects research and was exempted from further review.

Data for this study were obtained from PHIS, an administrative

Results

A total of 2,041 children from 44 hospitals were identified with acute myocarditis during the study period. The distribution of age was bimodal, with 1/4 of patients admitted at <1 year of age (25.6% [n = 522]) and slightly more than 1/4 admitted at >15 years of age (27.8% [n = 568]) (see Figure 1). Congenital heart disease was reported in 132 subjects (6.4%). Viral infection was indicated in 284 subjects (13.9%). The most frequently reported viruses were influenza, rhinovirus, and parvovirus,

Discussion

In this multicenter, retrospective database study, the presence of a clinically significant tachyarrhythmia was associated with increased in-hospital mortality, length of stay, and costs per day for children admitted with acute myocarditis. No associations were detected between the presence of bradyarrhythmias and the measured outcomes, after controlling for significant confounders.

Despite the significant morbidity and mortality that can be associated with pediatric myocarditis, limited data

Disclosures

The authors have no conflicts of interest to disclose.

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