Important Considerations in Pediatric Heart Failure
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HEART FAILURE (HJ EISEN, SECTION EDITOR)
Important Considerations in Pediatric Heart Failure J. Blake Wall 1 & Anastacia M. Garcia 2 & Roni M. Jacobsen 2 & Shelley D. Miyamoto 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The goal of this paper is to provide an overview of contemporary knowledge specific to the causes, management, and outcome of heart failure in children. Recent Findings While recently there have been subtle improvements in heart failure outcomes in children, these improvements lag significantly behind that of adults. There is a growing body of literature suggesting that pediatric heart failure is a unique disease process with age- and disease-specific myocardial adaptations. In addition, the heterogenous etiologies of heart failure in children contribute to differential response to therapies and challenge the ability to obtain meaningful results from prospective clinical trials. Summary Consideration of novel clinical trial designs with achievable but clinically relevant endpoints and focused study of the mechanisms underlying pediatric heart failure secondary to cardiomyopathies and structural heart disease are essential if we hope to advance care and identify targeted and effective therapies. Keywords Heart failure . Congenital heart disease . Cardiomyopathy
Introduction Heart failure (HF) is one of the leading causes of hospitalization in the USA and is associated with substantial deleterious effects on quality of life in adult and pediatric populations. In children, HF is a heterogeneous disease with congenital heart disease (CHD) and dilated cardiomyopathy (DCM) being the most common indication for heart transplantation in infants and older children in the USA, respectively (Fig. 1) [1]. Determining the true incidence of pediatric HF is challenging This article is part of the Topical Collection on Heart Failure * Shelley D. Miyamoto [email protected] J. Blake Wall [email protected] Anastacia M. Garcia [email protected] Roni M. Jacobsen [email protected] 1
New York Medical College, Valhalla, NY, USA
2
Division of Cardiology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, CO, USA
due to the lack of a standardized definition of pediatric HF [1–3, 4•]. While primary cardiomyopathies and CHD predominate in high-income countries, lower respiratory tract infections and anemia are the most common causes of HF in low income countries [5]. HF secondary to rheumatic heart disease, renal disorders, and HIV are also prevalent in certain regions of the world [5]. The most recent population-based studies suggest that the incidence of primary HF in children ranges from 0.9–3 per 100,000 in European studies [6–8] to 7.4 per 100,000 in Taiwan [9]. The medical management of pediatric HF is largely based on the same medications used to treat adult HF, including ACE inhibitors, beta-receptor antagonists, aldosterone antago
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