[Congestive heart failure in childhood. An epidemiologic study].

BACKGROUND: In contrast to the adult age group epidemiologic studies on congestive heart failure (CHF) in infancy and childhood are lacking.

METHODS: Retrospective study of all patients admitted to the University Children's Hospital Essen, Germany, between 1989 and 1998 with the ICD 9 code for congenital and acquired heart diseases, cardiomyopathies, arrhythmias, arterial und pulmonary hypertension, and other cardiovascular anomalies. CHF was defined by the typical symptoms, start and end of CHF by commencement and end of anticongestive therapy (ACE inhibitors and/or diuretics and/or digoxin). Prevalence and incidence of CHF were determined and related to all patients with congenital and acquired heart diseases and to all general pediatric inpatients at the Children's Hospital from 1989 to 1998. Within 10 years 1,755 children with heart diseases were admitted, 918 boys and 837 girls. 1,297 children suffered from congenital heart diseases, 167 from rhythm disturbances, 110 from cardiomyopathies and acquired heart diseases, while prematures and patients with systemic or pulmonary hypertension are not furthermore topic of this study.

RESULTS: CHF occurred in 587 (33.4%) out of 1,755 children with all congenital and acquired heart diseases, and in 507 (39.1%) out of 1,297 children with congenital heart defects (CHD). When postoperative CHF was excluded, CHF occurred in 23.7% of children with CHD. Cumulative incidence of CHF was 334 out of 1,000 patients with all heart diseases and 233 out of 1,000 general pediatric inpatients. For patients with CHD the incidence of CHF was 289 out of 1,000 patients with all heart diseases and 20.1 out of 1,000 general pediatric inpatients. Prevalence of CHF for children with heart diseases was 279 in 1,000 and 17.3 in 1,000 general pediatric inpatients, for children with CHD 261 in 1,000 and 16.1 in 1,000 general pediatric inpatients. CHF occurred in 70.6% during the 1st year of life and lasted for a mean of 15 months. Only in patients with cardiomyopathies and acquired heart diseases the incidence in infancy was not so pronounced. In 78% of patients with CHD CHF ends after an operation. Mortality: during the 10-year interval 111 out of 1,755 patients with heart diseases died, 81 of them for CHF. That gives an overall mortality of 6.3%, 18% following heart surgery or cardiac catheterization, 74% with signs of CHF. In patients with CHD mortality was 6.2%. Out of the 587 children with CHF, 81 (14%) died. 67% of deaths occurred during the 1st year of life, in patients with CHD even in 71%.

CONCLUSION: CHF is uncommon in infants and children with congenital or acquired heart disease, but has considerable mortality. As surgical or interventional therapy is well established in nearly all patients with CHD, prognosis is much better compared to adults. A prospective evaluation by a nationwide registry is necessary.