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The Pediatric Heart Failure Workforce:
A New Subcommittee, A New Movement

YUK M LAW, MD
Seattle Children's Hospital
Seattle, WA, USA


yuk.law@seattlechildrens.org

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The field of pediatric heart failure has come a long way. Just 16 years ago, coming out of fellowship, I felt fairly lonely in this field. There was clearly an interest among some cardiologists and even individuals who were our forerunners but, for the most part, if one was to find like-minded people and build a career in it, one had to branch out and turn to the adult heart failure world. I did that and discovered the exciting ideas, which are now accepted as evidence based, but at the time were just being tested in the clinical arena. I also witnessed the adult heart failure community taking shape and organizing itself into the Heart Failure Society of America, which has since grown to become the dominant heart failure organization in the world. I envied what was happening with my adult colleagues and the brighter prospect they could offer to their patients. With a better understanding of the pathogenesis, and the launch of numerous clinical trials that are now mechanistic based, it was inevitable that a trickle-down effect would stimulate a "movement" in pediatrics.

However, the cliché "children are not small adults" aptly applies to the field of heart failure as well. Even if the central pathogenesis for the progression of chronic heart failure exists in children, primary etiologies, manifestations, physiology, pharmacodynamics, comorbidities, and therefore response to therapy and natural history are unlikely to parallel that of adults. The key is to know the adult data and be clever about what to extract and how best to apply them to our pediatric patients. There is precedence in this endeavor, as the same had to be done in the early era of pediatric thoracic transplantation. Nevertheless, for the budding pediatric heart failurist, he/she has to be ambidextrous and be a student of not one but two fields.

That task of extrapolating adult data for children can be a tricky undertaking. When does one cross the line without evidence to back, such as when the overwhelming evidence proclaims carvedilol to be effective in adults yet it was a negative trial in children? Should we really not prescribe the medication until a properly powered study is performed? Each and every individual practitioner has to decide for himself/herself. However, he/she does not have to decide alone if we organize ourselves to learn, confer, and explore together. The power of the group should not be underestimated here.

Over the years, I see an increasing number of trainees wanting to learn more about heart failure and even pursue a career in it; hence the workforce supply is growing. On the flip side is the clinical demand. Although we cannot ascertain the healthcare impact of pediatric heart failure (yet), the registry studies from Australia and USA estimate the incidence of cardiomyopathy to be approximately 1 new case a year per 100,000 children. Based on projected American census data, that would mean 850 new cases a year. This is not a meager number. When we also consider many new cases arise in infants who will be followed by us throughout childhood, and the better survival of complex infant repairs, I surmise from my own program activity that pediatric heart failure will have a large an increasing impact on child health when considered in the context of what should otherwise be a healthy subpopulation in the Western world.

I believe we now have a critical mass of interested and dedicated practitioners to form our own organization: from nurses to surgeons to intensivists to pharmacists to scientists who will join cardiologists to lead a movement to advance the care of children with heart failure. When we began a simple email campaign to seek out interest, the response was highly enthusiastic, so much so that a large group of us met by squatting a conference room at the end of a pediatric session at the 2012 ISHLT meeting in Prague. The consensus was to create a new Pediatric Heart Failure Workforce under the Pediatric Council of ISHLT. This new movement "has legs" because, unlike a more recent movement (not to be named here as we shall not mix medicine with politics), we were embraced and supported by the Society's leadership as it took no time for the Pediatric Council and the Executive Board to endorse us. In essence, the movement has found a home within ISHLT. The new Workforce has high aims and strives to reach out to all who want to work together. I hope many of you will join us to advance the care of children with heart failure.


For additional information about the Pediatric Heart Failure Workforce, please contact Yuk Law at yuk.law@seattlechildrens.org or Pediatric Council Chair Melanie Everitt at Melanie.Everitt@imail.org.


Disclosure Statement: The author has no conflicts of interest to disclose, other than his uncanny resemblance to Chow Yun fat.