Abstract 4139576: Trends in Incidence, Therapies Utilized and Clinical Outcomes after Cardiac Medication Exposures in the Pediatric Population

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Background: Approximately 2 million exposures are reported to US poison centers annually with 56% <20yrs of age in 2022. Adverse events due to cardiac medication ingestions are well-known, but limited data exists on national trends and outcomes in pediatrics. Aims: This study describes the trends in incidence, therapies used, and outcomes after cardiac med exposure over the last decade in the pediatric population. Methods: A retrospective cohort study was conducted from the National Poison Data System from 2012-2022 for patients ≤ 19 yrs exposed to cardiac meds: anti-arrhythmics, β-blockers, calcium channel antagonists, and cardiac glycosides. Analyses were stratified by med class and age group for trends in incidence, therapies, and outcomes. Results: A total of 100223 cases of cardiac med exposures were reviewed: 74% (0-5 yr), 8% (6-12 yr), and 18% (13-19 yr). From 2012-2022, the annual incidence of exposures decreased by 6%; however, it increased by 82% in the 13-19 yr group. In 6-19 yr olds, there was an increase in exposures for all med classes except cardiac glycosides. There was a difference in the therapies used across med classes, and 2.2% of all cases required selected cardiorespiratory therapies (p<.001, Table 1). The outcomes also varied by med class (p<.001, Table 1). 11819 (11.8%) cases resulted in ICU admission, of which 64% were in the 13-19 yr group, and 1355 (1.4%) cases resulted in a major/fatal outcome. For all age groups, exposure to >1 med type had a higher proportion resulting in ICU admission (p<.001). Of those with a major/fatal outcome, 82% were in the age 13-19 yr group. For this age group, exposure to >1 med type had a higher proportion resulting in major/fatal outcome compared to any single med class except for anti-arrhythmics (p<.001). Chronic exposure was more likely to result in major/fatal outcome compared to acute exposures in followed cases (4.7% vs 1.6%, p<.001). Conclusions: Teenagers showed the largest increase in cardiac med exposures from 2012-2022 and the highest rates of ICU admissions and major/fatal outcomes. These findings underscore the need for heightened awareness when prescribing cardiac mediations and the importance of mental health screening in older children.

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