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

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Abstract

Heart failure metrics specific to the pediatric population are required to successfully implement quality improvement initiatives in children with heart failure. Medication use at the time of discharge following admission for decompensated heart failure has been identified as a potential quality metric in this population. This study aimed to report medication use at discharge in the current era for children admitted with acute decompensated heart failure. All patients < 21 years of age with an index admission (1/1/2011–12/31/2019) for acute heart failure and a coexisting diagnosis of cardiomyopathy were identified from the Pediatric Health Information System. Medication use patterns were described and compared across age groups and centers. A total of 2288 patients were identified for inclusion. An angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker (ACEi/ARB) was prescribed in 1479 (64.6%), beta blocker in 1132 (49.5%), and mineralocorticoid receptor antagonist (MRA) in 864 (37.8%) patients at discharge. The use of ACEi/ARB at discharge has decreased over time (64.6% vs. 69.6%, p = 0.001) and the use of beta blockers has increased (49.5% vs. 36.8%, p < 0.001) compared to a historical cohort (2001–2010). There is considerable variability in medication use across centers with an overall increase in beta blocker and decrease in ACEi/ARB use over time. Collaborative efforts are needed to standardize care and define quality metrics to identify best practices in the management of pediatric heart failure.

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Data Availability

The data used in this manuscript are available within the Pediatric Health Information System.

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Funding

There is no relevant funding to report for this manuscript.

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Authors and Affiliations

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

    Joseph Stidham

  2. Division of Pediatric Cardiology, University of Pittsburgh, Pittsburgh, PA, USA

    Brian Feingold

  3. Department of Pediatrics (Pediatric Cardiology), Stanford University, Palo Alto, CA, USA

    Christopher S. Almond & David N. Rosenthal

  4. Division of Pediatric Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Danielle S. Burstein

  5. Division of Pediatric Cardiology, Cincinnati Children’s Hospital, Cincinnati, OH, USA

    Paige Krack & Angela Lorts

  6. Division of Pediatric Cardiology, Texas Children’s Hospital, Houston, TX, USA

    Jack F. Price & Joseph A. Spinner

  7. Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, USA

    Kurt R. Schumacher

  8. Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA

    Justin Godown

Authors
  1. Joseph Stidham
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  2. Brian Feingold
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  3. Christopher S. Almond
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  4. Danielle S. Burstein
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  5. Paige Krack
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  6. Jack F. Price
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  7. Kurt R. Schumacher
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  8. Joseph A. Spinner
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  9. David N. Rosenthal
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  10. Angela Lorts
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  11. Justin Godown
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Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by Joseph Stidham, Justin Godown, and Brian Feingold. The first draft of the manuscript was written by Joseph Stidham and Justin Godown and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Justin Godown.

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Conflict of interest

Dr. Lorts is a consultant for Abbott, Berlin Heart, and SynCardia, Inc. None of the remaining authors have a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.

Ethical Approval

This project was approved by the Vanderbilt University Medical Center institutional review board with a waiver of informed consent.

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Stidham, J., Feingold, B., Almond, C.S. et al. Establishing Baseline Metrics of Heart Failure Medication Use in Children: A Collaborative Effort from the ACTION Network. Pediatr Cardiol 42, 315–323 (2021). https://doi.org/10.1007/s00246-020-02485-x

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  • DOI: https://doi.org/10.1007/s00246-020-02485-x

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