Acute Myocarditis in Children: a 10-year Nationwide Study (2007-2016) based on the Health Insurance Review and Assessment Service Database in Korea

Abstract

Background and objectives: We performed a nationwide study to assess the incidence, treatment patterns, and outcomes of acute myocarditis in Korean children.

Methods: The nationwide incidence, treatment patterns, and outcomes of acute myocarditis in Korean children were assessed using data between 2007 and 2016 from the Health Insurance Review and Assessment database.

Results: We investigated 1,627 children during the study period. The overall incidence of acute myocarditis was 1.4 per 100,000 children in 2007 and 2.1 per 100,000 children in 2016, which indicates a significant increase in the trend over time. A bimodal age distribution was observed with a larger peak in infancy and a smaller peak in the mid-teenage years. No sex difference was observed in the incidence rate of acute myocarditis in children aged ≤5 years (373 boys vs. 366 girls); however, the incidence rate of acute myocarditis in adolescents aged ≥13 years showed significant male preponderance (482 boys vs. 152 girls). Acute fulminant myocarditis occurred in 371 children (22.8%) who needed extracorporeal membrane oxygenation and/or mechanical ventilator support. Of the 371 children with acute fulminant myocarditis, 258 (69.5%) survived. The survival rate of children with acute fulminant myocarditis remained nearly identical over the 10-year study period.

Conclusions: This was the first nationwide epidemiological study to investigate acute myocarditis in Korean children. In our view, this study would help clinicians in decision-making and planning for optimal management of acute myocarditis in children.

Keywords: Children; Epidemiology; Korea; Myocarditis.

Figure 1. Incidence of acute myocarditis according to (A) sex, and (B) clinical manifestation in 2007–2016.

Figure 2. Age/sex distribution of patients with acute myocarditis.

Figure 3. Seasonal proportion (%) in the incidence of acute myocarditis.

Figure 4. Relative survival rates with acute fulminant myocarditis in Korea, 2007–2016.

Figure 5. Temporal trends in (A) care requirements, and (B) medications in acute myocarditis. ECMO indicates extracorporeal membrane oxygenation.

ECMO = extracorporeal membrane oxygenation; EMB = endomyocardial biopsy; IVIG = intravenous immunoglobulin; MRI = magnetic resonance imaging; NE = norepinephrine.