Key result
Pediatric heart failure management relies on multidisciplinary care and adult-extrapolated GDMT to promote reverse remodeling.
Why the study?
Limited evidence exists for medical therapies in pediatric HF, with approaches predominantly extrapolated from adult experience, highlighting the need to summarize state-of-the-art management.
Management of pediatric systolic heart failure relies heavily on extrapolating adult guideline-directed medical therapy due to a lack of pediatric-specific evidence.
HF staging guides pediatric management and prognosis; leaves open prospective validation across diverse etiologies.
Heart failure (HF) in children is a complex syndrome with multiple diverse etiologies and both acute and chronic presentations. Chronic presentations can persist throughout childhood and adolescence, and require diligent management with ongoing reassessment to maximize survival and quality of life. Stages of HF are key to recognize as they guide both management and inform prognosis. In more severe cases, children can present with signs of low cardiac output and circulatory collapse with potential to transition either to a chronic HF stage or progress to a need for advanced HF therapies. Morbidity and mortality are high. Managing HF requires a multi-disciplinary approach that can adapt to the needs of the different phases of childhood and adolescence. Treatment can include medications, nutritional support, activity modifications, and potentially surgical intervention, pacemaker, respiratory or mechanical support, or even heart transplantation. Limited evidence exists for almost all medical therapies used in the management of HF in children and approaches are predominantly extrapolated from extensive adult experience. There are multiple maladaptive pathways in the failing heart; medications that modify these maladaptive pathways promote "reverse remodelling" of the myocardium and are key to the management, forming the basis for "guideline directed medical therapy". The purpose of this review is to summarize the current state of the art management of systolic HF in children.
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Anne I. Dipchand (2024) conducted a review in Pediatric Heart Failure. Guideline directed medical therapy (GDMT) was evaluated. Management of pediatric heart failure relies on a multidisciplinary approach and guideline-directed medical therapies extrapolated from adult data to promote reverse remodeling of the myocardium.
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