First name
Laura
Middle name
M
Last name
Mercer-Rosa

Title

A population-based study of risk factors for heart failure in pediatric and adult-onset systemic lupus erythematosus.

Year of Publication

2020

Number of Pages

527-533

Date Published

2020 May 03

ISSN Number

1532-866X

Abstract

<p><strong>OBJECTIVES: </strong>The increased relative risk of heart failure (HF) from systemic lupus erythematosus (SLE) is greatest at younger ages, but the etiology remains unclear. We identified risk factors for HF in children and adults with SLE and evaluated associations between SLE manifestations and HF.</p>

<p><strong>METHODS: </strong>Incident SLE cases without preceding HF were identified using Clinformatics DataMart® (OptumInsight, Eden Prairie, MN) US claims data (2000-2015), and categorized by age of SLE onset (children 5-17, young adults 18-24, adults 25-44 years old). The primary outcome was the first HF ICD-9-CM diagnosis code (428.x), categorized as early-onset (&lt; 6 months) or delayed-onset. Multivariable logistic regression was used to identify factors associated with early or delayed-onset HF. Cox proportional hazards regression was used to identify time-dependent associations between the onset of SLE manifestations and incident HF.</p>

<p><strong>RESULTS: </strong>There were 523 (2.3%) HF cases among 1,466 children, 2,163 young adults and 19,349 adults age 25-44 with SLE. HF in children and young adults was early-onset in 50% and 60% of cases, respectively, compared to 35% of cases in adults 25-44 years old. There was a temporal association between incident myopericarditis and valvular disease diagnoses and early-onset HF, whereas nephritis and hypertension were more strongly associated with delayed-onset HF. Black race remained independently associated with a 1.5-fold increased HF risk at any time.</p>

<p><strong>CONCLUSION: </strong>Hypertension remains an important traditional CV risk factor across all ages and should be managed aggressively even in younger patients with SLE. Cardiac dysfunction due to acute cardiac manifestations of SLE may contribute to the very high relative incidence of early HF diagnoses among younger SLE patients. Therefore, future prospective studies will need to address heterogeneity in the types and severity of heart failure in order to determine etiology and which patients should be monitored.</p>

DOI

10.1016/j.semarthrit.2020.03.019

Alternate Title

Semin. Arthritis Rheum.

PMID

32446021

Title

Relationship between pulmonary artery acceleration time and pulmonary artery pressures in infants.

Year of Publication

2019

Date Published

2019 Jul 01

ISSN Number

1540-8175

Abstract

<p><strong>BACKGROUND: </strong>Pulmonary artery acceleration time measured by echocardiography inversely correlates with pulmonary artery pressures in adults and children older than 1&nbsp;year of age. There is a paucity of data investigating this relationship in young children, particularly among preterm infants.</p>

<p><strong>OBJECTIVE: </strong>To characterize the relationship between pulmonary artery acceleration time (PAAT) and pulmonary artery pressures in infants.</p>

<p><strong>DESIGN/METHODS: </strong>Patients ≤&nbsp;1&nbsp;year of age at Children's Hospital of Philadelphia between 2011 and 2017 were reviewed. Infants with congenital heart disease were excluded, except those with a patent ductus arteriosus&nbsp;(PDA), atrial septal defect&nbsp;(ASD), or ventricular septal defect&nbsp;(VSD). Linear regression analysis was used to assess the correlation between PAAT measured by echocardiography and systolic pulmonary artery pressure, mean pulmonary artery pressure, and indexed pulmonary vascular resistance from cardiac catheterization.</p>

<p><strong>RESULTS: </strong>Fifty-seven infants were included, of which 61% were preterm and 49% had a diagnosis of bronchopulmonary dysplasia. The median postmenstrual age and weight at catheterization were 51.1&nbsp;weeks (IQR 35.8-67.9&nbsp;weeks) and 4400&nbsp;g (IQR 3100-6500&nbsp;g), respectively. Forty-four infants (77%) had a patent ductus arteriosus (PDA). There was a weak inverse correlation between PAAT with mPAP (r&nbsp;=&nbsp;-0.35, P&nbsp;=&nbsp;0.01), sPAP (r&nbsp;=&nbsp;-0.29, P&nbsp;=&nbsp;0.03), and PVRi (r&nbsp;=&nbsp;-0.29, P&nbsp;=&nbsp;0.03).</p>

<p><strong>CONCLUSION: </strong>There is a weak inverse relationship between PAAT and pulmonary artery pressures. This relationship is less robust in our population of infants with a high incidence of PDAs compared to previous studies in older children. Thus, PAAT may be less clinically meaningful for diagnosing pulmonary arterial hypertension in infants, particularly those with PDAs.</p>

DOI

10.1111/echo.14430

Alternate Title

Echocardiography

PMID

31260138

Title

Emergency Department Visits by Children With Congenital Heart Disease.

Year of Publication

2018

Number of Pages

1817-1825

Date Published

2018 Oct 09

ISSN Number

1558-3597

Abstract

<p><strong>BACKGROUND: </strong>Data related to the epidemiology and resource utilization of congenital heart disease (CHD)-related emergency department (ED) visits in the pediatric population is limited.</p>

<p><strong>OBJECTIVES: </strong>The purpose of this analysis was to describe national estimates of pediatric CHD-related ED visits and evaluate medical complexity, admissions, resource utilization, and mortality.</p>

<p><strong>METHODS: </strong>This was an epidemiological analysis of ED visit-level data from the 2006 to 2014 Nationwide Emergency Department Sample. Patients age&nbsp;&lt;18 years with CHD were identified using International Classification of Diseases-9th Revision-Clinical Modification codes. We evaluated time trends using weighted regression and tested the hypothesis that medical complexity, resource utilization, and mortality are higher in CHD patients.</p>

<p><strong>RESULTS: </strong>A total of 420,452 CHD-related ED visits (95% confidence interval [CI]: 416,897 to 422,443 visits) were identified, accounting for 0.17% of all pediatric ED visits. Those with CHD were more likely to be&nbsp;&lt;1 year of age (43% vs. 13%), and to have&nbsp;≥1 complex chronic condition (35% vs. 2%). CHD-related ED visits had higher rates of inpatient admission (46% vs. 4%; adjusted odds ratio: 1.89; 95% CI: 1.85 to 1.93), higher median ED charges ($1,266 [interquartile range (IQR): $701 to $2,093] vs. $741 [IQR: $401 to $1,332]), and a higher mortality rate (1% vs. 0.04%; adjusted odds ratio: 1.25; 95% CI: 1.07 to 1.45). Adjusted median charges for CHD-related ED visits increased from $1,219 (IQR: $673 to $2,138) to $1,630 (IQR: $901 to $2,799), while the mortality rate decreased from 1.13% (95% CI: 0.71% to 1.52%) to 0.75% (95% CI: 0.41% to 1.09%) over the 9 years studied.</p>

<p><strong>CONCLUSIONS: </strong>Children with CHD presenting to the ED represent a medically complex population at increased risk for morbidity, mortality, and resource utilization compared with those without CHD. Over 9 years, charges increased, but the mortality rate improved.</p>

DOI

10.1016/j.jacc.2018.07.055

Alternate Title

J. Am. Coll. Cardiol.

PMID

30286926

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