Comparison of Heart Failure Etiology and Management in Pediatric and Adult Patients with Congenital Heart Diseases
DOI:
https://doi.org/10.21649/akemu.v32i1.6011Keywords:
Adult CHD, Arrhythmias, BNP levels, Heart Failure, pediatric CHD, pulmonary hypertensionAbstract
Background: Heart failure is a serious complication of congenital heart disease (CHD) in both pediatric and adult populations. Understanding differences in etiology, clinical presentation, and treatment strategies is essential for improving outcomes and guiding targeted management across age groups.
Objective: To compare the etiology, clinical features, and management of heart failure in pediatric and adult patients with congenital heart disease (CHD).
Methodology: This Comparative analytical study was carried out at Department of Cardiology, Cardiac Centre, Bahawal Victoria Hospital, Bahawalpur, from September 2023 to September 2024. A total of 200 patients were included, comprising 100 in the study group (50 pediatric and 50 adult CHD patients with heart failure) and 100 in the control group (50 pediatric and 50 adult CHD patients without heart failure). Data were analyzed for demographics, types of CHD, clinical features, management strategies, and outcomes. Ejection fraction (<55%) and elevated BNP levels were used to classify heart failure. Statistical analysis was performed using SPSS, with p-values <0.05 considered significant.
Results: This paper will compare the etiology, presentation, and treatment of pediatric heart failure as compared to the presentation and treatment in patients with congenital heart disease (CHD). They included 200 patients, 100 heart failure, and 100 no heart failure, 50 pediatric and 50 adult patients in each group. Complex CHD was more prevalent in the study group with a lower ejection fraction (72% vs. 12% p<0.001), and higher BNP (84=7210, p<0.001). The study group received medications like diuretics (88%) and ACE inhibitors (72%). The study group (45), versus the control group (70); surgical processes were less invasive in the former compared to the latter.
Conclusion:Risk factors such as impaired coronary arteries, late presentation and high complication rates are linked to CHD. The burden of heart failure in patients with CHD can be greatly minimized by early detection and management.
References
1. Agarwal A, Thombley R, Broberg CS, Cook SC, Rich JD, Valente AM, et al. Age- and lesion-related comorbidity burden among US adults with congenital heart disease: a population-based study. J Am Heart Assoc. 2019;8(20):013450. https://doi.org/10.1161/JAHA.119.013450
2. Bozkurt B, Coats AJS, Tsutsui H, Abdelhamid CM, Adamopoulos S, Albert N, et al. Universal definition and classification of heart failure: a report of the HFSA, HFA of the ESC, Japanese HF Society and writing committee. Eur J Heart Fail. 2021;23(3):352–80. https://doi.org/10.1002/ejhf.2115
3. Cleland JGF, Pfeffer MA, Clark AL, Krum H, Liu P, McMurray JJV, et al. The struggle towards a universal definition of heart failure—how to proceed? Eur Heart J. 2021;42(24):2331-43. https://doi.org/10.1093/eurheartj/ehab082
4. Burchill LJ, Gao L, Kovacs AH, Opotowsky AR, Maxwell BG, Moon-Grady AJ, et al. Hospitalization trends and health resource use for adult congenital heart disease–related heart failure. J Am Heart Assoc. 2018;7(15):008775. https://doi.org/10.1161/JAHA.118.008775
5. Arshad MS, Anwar-Ul-Haq HM, Adnan M, Zulqarnain A. Frequency and pattern of Paediatric Heart Diseases: Five years experience at The Children's Hospital, Multan. Pak J Med Sci 2020; 36(6): 1308-12. doi: 10.12669/pjms.36.6.2312.
6. Wang F, Liu A, Brophy JM, Marelli AJ, Therrien J. Determinants of survival in older adults with congenital heart disease newly hospitalized for heart failure. Circ Heart Fail. 2020;13(8):006490. https://doi.org/10.1161/CIRCHEARTFAILURE.119.006490
7. Emmons-Bell S, Johnson C, Roth G. Prevalence, incidence and survival of heart failure: a systematic review. Heart 2022; 108(17): 1351-60. https://doi.org/10.1136/heartjnl-2021-320131.
8. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135(10): 146-603. https://doi.org/10.1161/CIR.0000000000000485
9. Bibi S, Hussain Gilani SY, Bibi S. Spectrum Of Congenital Heart Disease In Full Term Neonates. J Ayub Med Coll Abbottabad 2018; 30(1): 67-70.
10. Gilljam T, Mandalenakis Z, Dellborg M, Eriksson P, Skoglund K, Rosengren A. Development of heart failure in young patients with congenital heart disease: a nation-wide cohort study. Open Heart. 2019;6(1):000858. https://doi.org/10.1136/openhrt-2018-000858
11. Aggarwal M, Bozkurt B, Panjrath G, Aggarwal B, Ostfeld RJ, Barnard ND, et al. American College of Cardiology’s Nutrition and Lifestyle Committee of the Prevention of Cardiovascular Disease Council. Lifestyle Modifications for Preventing and Treating Heart Failure. J Am Coll Cardiol 2018; 72(19): 2391-405. https://doi.org/10.1016/j.jacc.2018.08.2160
12. Patel Y, Joseph J. Sodium Intake and Heart Failure. Int J Mol Sci 2020; 21(24): 9474. https://doi.org/10.3390/ijms21249474
13. Machado d'Almeida KS, Rabelo-Silva ER, Souza GC, Trojahn MM, Santin Barilli SL, Aliti G, et al. Aggressive fluid and sodium restriction in decompensated heart failure with preserved ejection fraction: Results from a randomized clinical trial. Nutrition 2018; 54:111-17. https://doi.org/10.1016/j.nut.2018.02.007
14. Luchini C, Stubbs B, Solmi M, Veronese N. Assessing the quality of studies in meta-analyses: Advantages and limitations of the Newcastle Ottawa Scale. World J Meta-Anal. 2017; 5(4): 80-4. http://doi.org/10.13105/wjma.v5.i4.80
15. Li J, Zhen Z, Huang P, Dong YG, Liu C, Liang W. Salt restriction and risk of adverse outcomes in heart failure with preserved ejection fraction. Heart 2022;108(17):1377-82. https://doi.org/10.1136/heartjnl-2022-321167
16. Ivey-Miranda JB, Almeida-Gutierrez E, Herrera-Saucedo R, Posada-Martinez EL, Chavez-Mendoza A, Mendoza-Zavala GH, et al. Sodium restriction in patients with chronic heart failure and reduced ejection fraction: A randomized controlled trial. Cardiol J. 2023;30(3):411-21. https://doi.org/10.5603/CJ.a2021.0098
17. Kalogeropoulos A, Papadimitriou L, Georgiopoulou VV, Dunbar SB, Skopicki H, Butler J, et al. Low- Versus Moderate-Sodium Diet in Patients With Recent Hospitalization for Heart Failure: The PROHIBIT (Prevent Adverse Outcomes in Heart Failure by Limiting Sodium) Pilot Study. Circ Heart Fail 2020; 13(1): 006389. https://doi.org/10.1161/CIRCHEARTFAILURE.119.006389
18. Khan MS, Jones DW, Butler J. Salt, No Salt, or Less Salt for Patients With Heart Failure? Am J Med 2020; 133(1): 32-8. https://doi.org/10.1016/j.amjmed.2019.07.034
19. Wang K, Chu C, Hu J, Wang Y, Zheng W, Lv Y, et al. Effect of Salt Intake on the Serum Cardiotrophin-1 Levels in Chinese Adults. Ann Nutr Metab 2018; 7 3(4): 302-9.
https://doi.org/10.1159/000494436
20. Iftikhar Ul Husnain M, Rashid M, Shakoor U. Decision-making for birth location among women in Pakistan: evidence from national survey. BMC Pregnancy Childbirth. 2018; 18(1): 226. doi: 10.1186/s12884-018-1844
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Annals of King Edward Medical University

This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments publications@kemu.edu.pk