Background: Acute myocarditis, a primary inflammatory cardiac disease commonly caused by viral infection, is an important cause of morbidity and mortality in children. Data obtained from forensic studies found an incidence of 15–33% for acute myocarditis in sudden deaths in the pediatric age group. Currently, there is a lack of data regarding the incidence and factors associ- ated with short-term outcomes in pediatric patients admitted for acute myocarditis. The aim of the study was to identify predictors for in-hospital mortality in a pediatric population admitted with acute myocarditis. Material and methods: We conducted a retrospective observational cohort study that included 21 patients admitted for acute myocarditis. Clinical, laboratory, ECG, and im- aging data acquired via 2D transthoracic echocardiography and cardiac magnetic resonance im- aging were collected from the medical charts of each included patient. The primary end-point of the study was all-cause mortality occurring during hospitalization (period ranging from 10 to 14 days). The study population was divided into 2 groups according to the occurrence of the primary end-point. Results: The mean age of the study population was 99.62 ± 77.25 months, and 61.90% (n = 13) of the patients were males. The in-hospital mortality rate was 23.9% (n = 5). Patients in the deceased group were significantly younger than the survivors (55.60 ± 56.18 months vs. 113.4 ± 78.50 months, p = 0.039). Patients that had deceased presented a significantly higher level of LDH (365 ± 21.38 U/L vs. 234.4 ± 63.30 U/L, p = 0.0002) and a significantly higher rate of ventricular ex- trasystolic dysrhythmias (60% vs. 6.25%, p = 0.02, OR: 22.5, 95% CI: 1.5–335) compared to survi- vors. The 2D echocardiography showed that patients that had deceased presented more frequently an impaired left ventricular ejection fraction (<30%) (p = 0.001) and a significantly higher rate of severe mitral regurgitation (p = 0.001) compared to survivors. Conclusions: The most powerful predictors for in-hospital mortality in pediatric patients admitted for acute myocarditis were the presence of ventricular extrasystolic dysrhythmias on the 24h Holter ECG monitoring, impaired left ventricular systolic function (LVEF <30%), the presence of severe mitral regurgitation, and confirmed infection with Mycoplasma pneumoniae.

ABSTRACT

Background: Ferric carboxymaltose (FCM) treatment in case of iron deficient (ID) patients with chronic heart failure (CHF) has shown great promise according to the findings of recent studies in improvement of symptoms and quality of life, New York Heart Association (NYHA) classifica- tion, and exercise capacity. Aim of the study: The purpose of the current study is to assess the budget impact of treating CHF patients with FCM in a sample of Romanian hospitals. Material and methods: Calculations have been based on the budget impact model developed by Theidel et al. The assumptions and clinical outcomes of the current study were based on a multivariate statisti- cal approach used in the same German study. The predicted outcomes were based on data pooled from four double-blind randomized controlled trials. The time horizon of the model was 1 year. Budget impact calculations were performed from the public payer perspective. Two scenarios have been handled: one without applying the Clawback tax and one with applying the tax to the cost of medication. Results: The yearly budget impact of FCM vs. no iron-replacement treatment without applying the tax ranged between €678,383 and €641,588 for 1,000 patients, resulting in €37 of additional costs per patient per year. The yearly budget impact of FCM vs. no iron-replacement treatment with applying the tax ranged between €616,934 and €641,588 for 1,000 patients, re- sulting in €9 of cost reduction per patient per year. Key cost drivers included the cost of outpatient visits and the cost of hospitalization due to HF worsening. Sensitivity analysis for both scenarios proved the robustness of the results. Conclusions: The FCM treatment of CHF patients has a mod-erate budget impact. Moreover, this budget impact/saving translates into a reduction of the rate and length of hospitalization stay and a better symptomatic profile of the patients.