The Incidence of Heart Failure in Children with Congenital Heart Disease: A Prospective Cohort Study

Background: Pediatric heart failure (HF) poses diagnostic challenges, especially in emergency settings, where misdiagnoses are common. Aim: This study aimed to investigate the causes of HF in children with congenital heart disease (CHD) and provide insights into age-related disparities and clinical classifications. Methods: A prospective observational cohort study was conducted on 402 pediatric patients with CHD during the years 2019-2020. Ultimately, 45 pediatric patients diagnosed with HF by two pediatric cardiologists based on clinical symptoms and radiographic changes were included in the study. Information from the patients' files, including epidemiological findings, clinical examinations, paraclinical findings, and interventions performed, was recorded. Etiological factors and clinical classifications were analyzed using statistical tests. Results: Among 402 pediatric patients with CHD, 45 (11.19%) were diagnosed with HF, with a median age of 7.5 months. The predominant etiological factors included ventricular septal defect (VSD), atrial septal defect (ASD), and cardiomyopathy. CHD was prevalent in 86.66% of the cases. Clinical classifications revealed age-related differences, emphasizing the heterogeneity of pediatric HF presentations. Conclusion: Considering that 86.7% of the patients with HF in our study had CHD, more investigations into the causes and mechanisms of this issue are necessary, which will be possible with genetic studies. A significant difference was observed between Class II and Class IV, with Class II patients being older and heavier, and having a lower heart rate compared to those in Class IV. This aligns with the classifications, where Class II indicates mild symptoms during ordinary activity, while Class IV signifies severe symptoms at rest.