One-Year Post-Diagnosis Outcome of Children Aged Less Than 12 Years with Dilated Cardiomyopathy at Kenyatta National Hospital

Abstract

BACKGROUND: In Africa, dilated cardiomyopathy (DCM) in children is the main factor contributing to heart failure. Outcomes vary from complete recovery to death or cardiac transplant. The outcomes of children with DCM at Kenyatta National Hospital (KNH) are neither known nor documented.

OBJECTIVES: To determine the mortality outcome and factors associated with mortality of children with DCM at KNH 1 year post-diagnosis.

METHODOLOGY: This was a retrospective cohort study on children diagnosed with DCM in KNH from January 2016 to December 2022. After the Ethics Research Committee (ERC) approval, data collected from the patients' records included demographics, clinical presentation at diagnosis, first diagnostic echocardiogram, medications, follow-up echocardiogram, and patient outcome.

RESULTS: A total of 192 patients were included in the study. The median age at diagnosis was 14 months (IQR: 9-24 months). The majority of the patients presented with cough 177 (92.2%), difficulty breathing 167(86.9%), hepatomegaly 124(64.6%), edema 112(58.3%), and 175(92.3%) had cardiomegaly on the chest radiograph. The mortality outcome was a cumulative incidence proportion of 9.9% (95% CI, 5.68% to 14.12%). While using fractional shortening Z scores, 36.4% (95% CI, 27.2% to 46.7%) of children had recovered echocardiogram, and 56% (95% CI, 46.6% to 65.7%) using left ventricular ejection fraction(LVEF). Factors associated with mortality included;age in months(aHR 0.982,p=0.033),edema(aHR 2.811,p=0.073), while a higher LVEF(aHR 0.894,p=<0.001) at diagnosis, treatment with enalapril (aHR 0.309,p=0.021)and digoxin(aHR 0.131,p=0.003) were protective.

CONCLUSION & RECOMMENDATIONS: The mortality outcome was approximately 10%. One-third of the patients had a recovered echocardiogram. A higher LVEF at diagnosis and treatment with digoxin and enalapril were associated with survival. Patients with DCM should be initiated on digoxin and enalapril since these medications are associated with survival. Further studies are required to understand the reasons for the loss of clinical follow-up of children with DCM at KNH.