Demographics, Trends, and Outcomes in Pediatric Acute Myocarditis in the United States, 2006 to 2011

• Published in: Circulation Cardiovascular quality and outcomes Vol. 5; no. 5; pp. 622 - 627
• Main Authors: GHELANI, Sunil J, SPAEDER, Michael C, PASTOR, William, SPURNEY, Christopher F, KLUGMAN, Darren
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.09.2012
• Subjects: Acute Disease; Adolescent; Age Distribution; Age Factors; Biological and medical sciences; Biopsy - trends; Cardiology. Vascular system; Cardiovascular Agents - adverse effects; Cardiovascular Agents - therapeutic use; Chi-Square Distribution; Child; Child, Preschool; Extracorporeal Membrane Oxygenation - adverse effects; Extracorporeal Membrane Oxygenation - mortality; Extracorporeal Membrane Oxygenation - trends; Female; Healthcare Disparities - trends; Heart; Heart Transplantation - adverse effects; Heart Transplantation - mortality; Heart Transplantation - trends; Heart-Assist Devices - adverse effects; Heart-Assist Devices - trends; Humans; Infant; Linear Models; Logistic Models; Magnetic Resonance Imaging - trends; Male; Medical sciences; Multivariate Analysis; Myocarditis - diagnosis; Myocarditis - epidemiology; Myocarditis - mortality; Myocarditis - physiopathology; Myocarditis - therapy; Myocarditis. Cardiomyopathies; Odds Ratio; Practice Patterns, Physicians' - trends; Predictive Value of Tests; Recovery of Function; Residence Characteristics; Retrospective Studies; Risk Assessment; Risk Factors; Survival Analysis; Time Factors; Treatment Outcome; United States - epidemiology; Young Adult; United States; North America; America; Human; Pediatrics; Demography; Prognosis; Acute; Trend; Variations; Cardiovascular disease; regional variation; Regional; Epidemiology; Myocardial disease; Myocarditis; outcomes; Heart disease; Child
• ISSN: 1941-7713; 1941-7705
• DOI: 10.1161/circoutcomes.112.965749

There is a lack of clear diagnostic and management guidelines for acute myocarditis in the pediatric population. We used a multi-institutional database to characterize demographics, practice variability, and outcomes in this population. Patients with acute myocarditis (n=514) were identified from April 2006 to March 2011 using the Pediatric Health Information System database, and regional variations in management and outcomes were analyzed. Ninety-seven patients (18.9%) received extracorporeal membrane oxygenation, 22 (4.3%) received ventricular assist device, 21 (4.1%) received heart transplantation, and 37 (7.2%) died. Of the 104 patients who received extracorporeal membrane oxygenation or ventricular assist device, 17 (16.3%) had heart transplantation, 25 (24%) died, and 62 (59.6%) showed recovery of myocardial function. There was a decrease in the use of endomyocardial biopsy (P=0.03) and an increase in the use of magnetic resonance imaging (P<0.01) over the study period. Although the use of medications and procedures varied between different regions, the occurrence of death or heart transplantation showed no significant regional associations. The use of extracorporeal membrane oxygenation (odds ratio, 5.8; 95% confidence interval, 2.9-11.4; P<0.01), ventricular assist device (odds ratio, 8.2; 95% confidence interval, 2.7-24.9; P<0.01), and vasoactive medications (odds ratio, 5.7; 95% confidence interval, 1.2-26.1; P=0.03) was independently associated with death/transplantation. There is significant temporal and regional variation in the diagnostic modalities and management used for pediatric myocarditis, which continues to have high morbidity and mortality. Extracorporeal membrane oxygenation, ventricular assist device, and vasoactive medications are independently associated with increased mortality/transplantation.