Pediatric heart failure: Current approach and treatment

Abstract

Pediatric heart failure (HF) is a heterogenous disease process. While the incidence is low compared to adults, resource utilization and in hospital mortality is higher. We aim to review the current approaches and treatment strategies for pediatric HF and discuss ongoing efforts to improve outcomes for this patient population. Pediatric HF is a diverse disease entity with variable pathophysiologic processes and symptoms. This review will focus on myocardial failure related to intrinsic cardiomyocyte, or cardiac muscle cell, dysfunction. While myocardial failure is a shared pathway in adult and pediatric HF, unique disease mechanisms are observed in pediatric patients, providing potential explanations for why existing HF treatment regimens are more effective in adults than children. Diagnosis and serial assessment of pediatric HF is achieved by employing multimodality imaging techniques, laboratory evaluation, and cardiac catheterization, as well as sleep and exercise studies. Pharmacologic therapies are largely based on adult guideline directed medical therapy, although supportive evidence is lacking in pediatric HF. Novel therapies are being developed that have potential for efficacy based on the current understanding of pediatric specific HF pathophysiology. Medical therapy for HF is often complemented by non-pharmacologic therapies, and in cases of end stage HF, patients may require ventricular assist devices or heart transplantation. The current approaches and treatments of pediatric HF face unique challenges; however, there is reason for an optimistic future. Improved outcomes can be achieved by utilizing emerging therapies and technologies, increasing collaboration, and through a dedication to delivering equitable care.

Keywords: ACE inhibitors; Beta-blockers; Cardiomyopathy; Children; Heart failure.

Figure 1

Non-pharmacologic therapies to be used in conjunction with pharmacotherapy in pediatric patients with heart failure., , , , , , , , Created in BioRender. https://BioRender.com/f97m245.