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Establishing Baseline Metrics of Heart Failure Medication Use in Children: A Collaborative Effort from the ACTION

Joseph Stidham1, Brian Feingold2, Christopher S Almond3

  • 1Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.

Pediatric Cardiology
|October 12, 2020
PubMed

Insights

Pediatric heart failure medication use at discharge shows a decrease in ACEi/ARB and an increase in beta blockers over time. Variability across centers highlights the need for standardized pediatric heart failure care.

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Pharmacology
  • Health Services Research

Background:

  • Pediatric heart failure requires specific quality metrics for effective care improvement.
  • Medication use at discharge is a key potential quality indicator for children with heart failure.

Purpose of the Study:

  • To report current medication use patterns at discharge for pediatric patients admitted with acute decompensated heart failure.
  • To compare medication use across different age groups and healthcare centers.

Main Methods:

  • Retrospective analysis of 2288 patients (<21 years) admitted for acute heart failure and cardiomyopathy (2011-2019).
  • Data extracted from the Pediatric Health Information System.
  • Medication patterns described and compared, including angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB), beta blockers, and mineralocorticoid receptor antagonists (MRA).

Main Results:

  • At discharge, 64.6% received ACEi/ARB, 49.5% received beta blockers, and 37.8% received MRA.
  • Compared to a historical cohort (2001-2010), ACEi/ARB use decreased (64.6% vs. 69.6%), while beta blocker use increased (49.5% vs. 36.8%).
  • Significant variability in medication prescribing was observed across different centers.

Conclusions:

  • Current pediatric heart failure discharge medication patterns show evolving trends with increased beta blocker and decreased ACEi/ARB use.
  • Substantial variation in prescribing practices across institutions necessitates collaborative efforts.
  • Standardization of care and definition of quality metrics are crucial for optimizing pediatric heart failure management.

Keywords:
Heart failureMedicationPediatricQuality improvement

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