National prescribing trends for heart failure medications in children

The treatment of acute decompensated heart failure (ADHF) in adults has changed considerably over the past decade, and these changes have coincided with a reduction in inpatient mortality. At this time, national trends in medication prescribing among children hospitalized with ADHF are unknown.

The Pediatric Health Information System (PHIS) database was queried to identify all patients ≤21 years of age who were admitted from 2001 to 2010 with ADHF and a diagnosis of cardiomyopathy. Patients were excluded for potential infectious or inflammatory etiologies of heart failure, congenital heart disease, cardiovascular surgery, acute heart transplant rejection, or isolated diastolic dysfunction. Only the index admission was used, and descriptive statistical methods were employed.

A total of 1773 patients (55.8% male) met study criteria (mortality 6.9%). Median length of stay was 9 days (IQR 4-16 days). Vasopressor or inotropic agents were used in 63.6% of patients (milrinone in 82.9% of these) and diuretics in 90.1% (furosemide in 98.4% of these). At discharge, a beta-blocker was prescribed in 36.8% of patients (carvedilol in 77.1% of these), and an angiotensin-converting enzyme (ACE) inhibitor was prescribed in 69.6% (enalapril in 59.9% of these). A wide variability in prescribing practices over time and by pediatric hospital was noted, along with a trend for decreased inotrope use and an increase in beta-blocker discharge prescribing.

This is the first national evaluation of prescribing trends in pediatric ADHF medication. A large degree of variability in medication use for ADHF and low rates of beta-blocker and ACE inhibitor use at discharge were identified.