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Changes in Provider Prescribing Behavior for Infants with Single Ventricle Physiology After Evidence-Based Publications

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Abstract

Background

The impact of published evidence on clinical practice has been understudied in pediatric cardiology.

Objective

We sought to assess changes in prescribing behavior for angiotensin-converting enzyme inhibitor (ACEI) and digoxin at discharge after initial palliation of infants with single ventricle (SV) physiology following the publication of two large studies: The Pediatric Heart Network Infant Single Ventricle (PHN-ISV) trial showing no benefit with routine ACEI use and the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) analysis showing an association between digoxin and survival.

Methods

ICD-9-10 codes identified SV infants from the Pediatric Health Information System (1/2004 to 1/2018) and charge codes identified medications at discharge. Generalized estimating equations implementing segmented logistic regressions modeled medication use, before and after (with a 3-month washout period) the relevant publication (ACEI 7/1/2010; digoxin 4/1/2016). A subgroup analysis was performed for hypoplastic left heart syndrome (HLHS).

Results

ACEI use (37 centers, n = 4700) at discharge did not change over time during the pre-publication period. After publication of the PHN-ISV trial, ACEI use decreased (OR: 0.61, CI 0.44–0.84, p = 0.003). Digoxin use (43 centers, n = 4778) decreased by 1% monthly before publication. After the NPC-QIC publication, digoxin use increased (OR: 2.07, CI 1.05–4.08, p = 0.04) with an ongoing increase of 9% per month. Results were similar for the HLHS subgroup.

Conclusions

Prescribing behavior changed congruently after the publication of evidence-based studies, with decreased ACEI use and increased digoxin use at discharge following initial palliation of SV infants. Our findings suggest scientific findings were rapidly implemented into clinical practice.

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Data Availability

All data included in the analysis may be obtained through the use of the Pediatric Health Information System (PHIS) database.

Code Availability

Not applicable.

Abbreviations

ACEI:

Angiotensin-converting enzyme inhibitor

ECMO:

Extracorporeal membrane oxygenation

HLHS:

Hypoplastic left heart syndrome

IQR:

Interquartile range

ISV:

Infant single ventricle

LOS:

Length of stay

NPC-QIC:

National Pediatric Cardiology Quality Improvement Collaborative

PHIS:

Pediatric Health Information System

PHN:

Pediatric Heart Network

SV:

Single ventricle

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Acknowledgements

The authors would like to thank the University of Utah Health System and Intermountain Healthcare, as well as the University of Utah Population Health Research (PHR) Foundation, National Center for Research Resources, National Center for Advancing Translational Sciences, and National Institutes of Health.

Funding

This investigation was supported by the University of Utah Population Health Research (PHR) Foundation, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR002538 (formerly 5UL1TR001067-05, 8UL1TR000105, and UL1RR025764).

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Authors and Affiliations

  1. University of Utah Division of Pediatric Cardiology and Primary Children’s Hospital, 81 N. Mario Capecchi Drive, Salt Lake City, UT, 84113, USA

    Derek L. Weyhrauch, Dongngan T. Truong, Nelangi M. Pinto, Venugopal Amula, Linda M. Lambert, L. LuAnn Minich & Richard V. Williams

  2. Division of Epidemiology, University of Utah, Salt Lake City, UT, USA

    Chong Zhang & Angela P. Presson

  3. Pediatric Analytics, Intermountain Healthcare, Salt Lake City, UT, USA

    Jacob Wilkes

Authors
  1. Derek L. Weyhrauch
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  2. Dongngan T. Truong
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  3. Nelangi M. Pinto
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  4. Venugopal Amula
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  5. Linda M. Lambert
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  6. Chong Zhang
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  7. Angela P. Presson
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  8. Jacob Wilkes
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  9. L. LuAnn Minich
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  10. Richard V. Williams
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Corresponding author

Correspondence to Derek L. Weyhrauch.

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Weyhrauch, D.L., Truong, D.T., Pinto, N.M. et al. Changes in Provider Prescribing Behavior for Infants with Single Ventricle Physiology After Evidence-Based Publications. Pediatr Cardiol 42, 1224–1232 (2021). https://doi.org/10.1007/s00246-021-02606-0

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