Trends in hospitalization and factors associated with in-hospital death
among pediatric admissions with implantable cardioverter defibrillators
Background: As pediatric implantable cardioverter defibrillator (ICD)
utilization increases, hospital admission rates will increase. Data
regarding hospitalizations among pediatric patients with ICDs is
lacking. In addition, hospital mortality rates are unknown. This study
aimed to evaluate 1) trends in hospitalization rates of admissions over
20 years, 2) hospital mortality, and 3) factors associated with hospital
mortality among pediatric admissions with ICDs. Methods: The Kids’
Inpatient Database (2000-2016) 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. Results: Of 42,570,716
hospitalizations, 4165 were admitted <21 years with an ICD.
ICD admissions increased four-fold (p = 0.002) between 2000-2016.
Hospital death occurred in 54 (1.3%). In multivariable analysis,
cardiomyopathy (OR 3.5, 95%CI 1.1–11.2, p=0.04) and CHD (OR 4.8,
95%CI 1.5–15.6, p=0.01) 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<0.0001).
Conclusions: Pediatric ICD hospitalization 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.