Introduction: With increasing health care costs, complex conditions such as heart failure (HF) are becoming more resource intensive. The epidemiology of HF among pediatric patients is relatively unknown, as well as associated resource utilization. This vulnerable population is complex, with many associated comorbidities.
Hypothesis: We aimed to test the hypothesis that complex chronic conditions and resource utilization among pediatric heart failure related (HFR) emergency department (ED) visits has increased over time in a nationally representative dataset.
Methods: The National Emergency Department Survey (NEDS) is a nationally representative sample of approximately 135 million emergency department visits across the United States from 2007-2014. Pediatric HFR patient visits were identified via age (<18 years) and ICD-9 codes for heart failure. Complex chronic conditions were coded for 7 common diagnosis groups. Demographic and clinical characteristics are reported. Sample weights are used respective to each year of data.
Results: The number of HFR ED visits was stable over time with 5233 in 2007 to 4656 in 2014. In 2014, the mean age of these patients was 4.9 years(SE 0.2), 48%(SE 1.6) were females, and CHD was the diagnosis in 45%(SE 1.6), and cardiomyopathy in 10%(SE 1.0). The most common chronic condition (other than cardiac/congenital or genetic) was gastrointestinal (17.0%), followed by neuromuscular (7.9%) and metabolic (6.8%). The proportion of HFR ED visits with 3 or more complex chronic conditions rose from 12.4% in 2007 to 18.1% in 2014. Median total charges for HFR ED visit increased by 47% between 2007 to 2014 [$1296 (CI 1243-1349) to $1908 (CI 1766-2055), respectively]. For HF patients with 3+ complex chronic conditions, mean total charges increased 79% from $1360(SE 101) to $2434(SE 182).
Conclusions: While the total HFR ED visits over the decade from 2007 to 2014 remained stable, the proportion of pediatric HFR ED visits with complex chronic conditions increased along with charges associated with care. These results highlight the increasing complexity of pediatric HF patients and the need for further study to develop optimal care models in this challenging population.