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Trends in hospitalization and factors associated with in-hospital death among pediatric admissions with implantable cardioverter defibrillators
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  • Amna Qasim,
  • Tam Dan Pham ,
  • Jeffrey Kim,
  • Santiago Valdes,
  • Taylor Howard,
  • Matthew Diaz,
  • Shaine Morris,
  • Christina Miyake
Amna Qasim
Baylor College of Medicine

Corresponding Author:[email protected]

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Tam Dan Pham
Baylor College of Medicine
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Jeffrey Kim
Baylor College of Medicine
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Santiago Valdes
Baylor College of Medicine
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Taylor Howard
Baylor College of Medicine
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Matthew Diaz
University of Miami Miller School of Medicine
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Shaine Morris
Baylor College of Medicine
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Christina Miyake
Texas Children\'s Hospital
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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.
08 Oct 2021Submitted to Journal of Cardiovascular Electrophysiology
19 Oct 2021Submission Checks Completed
19 Oct 2021Assigned to Editor
21 Oct 2021Reviewer(s) Assigned
22 Nov 2021Review(s) Completed, Editorial Evaluation Pending
24 Nov 2021Editorial Decision: Revise Minor
02 Dec 20211st Revision Received
06 Dec 2021Submission Checks Completed
06 Dec 2021Assigned to Editor
11 Dec 2021Reviewer(s) Assigned
19 Dec 2021Review(s) Completed, Editorial Evaluation Pending
21 Dec 2021Editorial Decision: Accept
Mar 2022Published in Journal of Cardiovascular Electrophysiology volume 33 issue 3 on pages 502-509. 10.1111/jce.15347