1. 2014 Texas Pediatric Society Electronic Poster Contest
Impact of 2007 American Heart Association Infective Endocarditis Prevention Guidelines on Pediatric Hospital Admissions: A US Population-Based Study
Arpan R. Doshi, M.D., PGY6, Chandra Srinivasan, M.D., Mousumi Moulik, M.D.
Division of Pediatric Cardiology, University of Texas Medical School at Houston
Abstract
Table
American Heart Association published new guidelines for infective endocarditis prevention in the year This retrospective study examined inpatient admissions for infective endocarditis using nationally representative Kids’ inpatient database (KID), for the years 2006 and The findings of this study concluded that the 2007 American Heart Association endocarditis prevention guidelines did not have a significant impact on the overall rate of hospital admissions for infective endocarditis in the year 2009 compared to However, there was a significant decline in infective endocarditis admissions with associated diagnosis of isolated ventricular septal defect (VSD). Non-white race and congenital heart disease (CHD), particularly isolated patent ductus arteriosus (PDA), left ventricular outflow tract obstruction (LVOTO) and right ventricular outflow tract obstruction (RVOTO) lesions were significantly associated with increased mortality in infective endocarditis admissions on univariate analysis.
Table : Factors associated with mortality in children with IE on Univariate Analysis
Factor
Mortality, %
(95% CI)
Odds Ratio
P Value
Non-White Race
7.54 (2.50 – 5.47)
1.96 (1.22 – 3.15)
0.005
Any CHD
8.09 (5.91 – 10.28)
2.33 (1.51 – 3.60)
<0.001
Isolated PDA
21.35 (5.48 – 37.23)
5.09 (1.95 – 13.28)
LVOTO Group
12.07 (7.72 – 16.43)
2.95 (1.83 – 4.75)
RVOTO Group
12.51 (4.01 – 21.02)
2.66 (1.17 – 6.05)
0.019
Introduction
Figure
The 2007 American Heart Association guidelines for the prevention of infective endocarditis1 called for a major change in indications for antibiotic prophylaxis. These guidelines made significant changes in regards to antibiotic prophylaxis in patients with congenital heart diseases. No studies have been done to evaluate the impact of these changes on pediatric hospital admissions at the national level.
Purpose
Purpose of this study was to evaluate the national trends and mortality in infective endocarditis; its associations with congenital heart disease; and the impact of 2007 American Heart Association infective endocarditis prevention guidelines.
Methods
This retrospective study examined inpatient admissions (age <20 yrs) for IE using nationally representative Kids’ inpatient database2, for the years 2006 and Complex sample analysis was performed to obtain weighted estimates of incidence and mortality rates on congenital heart disease associated with infective endocarditis admissions. Categorized variables related to hospital and patient demographics were also studied.
Conclusions
The 2007 American Heart Association endocarditis prevention guidelines did not have a significant impact on the overall rate of hospital admissions for infective endocarditis in the year 2009 compared to However, there was a significant decline in infective endocarditis admissions with associated diagnosis of isolated ventricular septal defect. The increase noted in the number of infective endocarditis admissions with associated isolated atrial septal defect is likely a confounding bias. Non-white race and congenital heart disease, particularly isolated patent ductus arteriosus, left ventricular outflow tract obstruction and right ventricular outflow tract obstruction lesions were significantly associated with increased mortality in infective endocarditis admissions on univariate analysis.
Results
Out of 7.56 and 7.37 million total admissions in the years 2006 and 2009, there were 1,515 (95% CI 1,329-1,701) and 1,323 (95% CI 1,157-1,489) hospital admissions for infective endocarditis, respectively (P = 0.072). While the incidence of infective endocarditis-related admissions associated with isolated atrial septal defect increased significantly in year 2009 (P < 0.001), there was a decline (P = 0.020) in admissions associated with isolated ventricular septal defect. There was no significant change seen in the distribution of other congenital heart disease groups (Figure).
There was no significant change in overall mortality rate associated with infective endocarditis-related admissions between the years 2006 and 2009 (P = 0.440). Non-white race and congenital heart disease were significant factors associated with mortality in infective endocarditis-related admissions. Among congenital heart disease associated with infective endocarditis admissions, isolated patent ductus arteriosus, left ventricular outflow tract obstruction, right ventricular outflow tract obstruction were significantly associated with increased mortality on univariate analysis (Table).
References
Wilson W et al; A guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation Oct 9;116(15):
HCUP Kids’ Inpatient Database (KID). Healthcare Cost and Utilization Project (HCUP) and Agency for Healthcare Research and Quality, Rockville, MD. 
2014 Texas Pediatric Society Electronic Poster Contest