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Trends in Discharge Prescription of Digoxin After Norwood Operation: An Analysis of Data from the Pediatric Health Information System (PHIS) Database

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Abstract

Quality improvement efforts have focused on reducing interstage mortality for infants with hypoplastic left heart syndrome (HLHS). In 1/2016, two publications reported that use of digoxin was associated with reduced interstage mortality. The degree to which these findings have affected real world practice has not been evaluated. The discharge medications of neonates with HLHS undergoing Norwood operation between 1/2007 and 12/2018 at Pediatric Health Information Systems Database hospitals were studied. Mixed effects models were calculated to evaluate the hypothesis that the likelihood of digoxin prescription increased after 1/2016, adjusting for measurable confounders with furosemide and aspirin prescription measured as falsification tests. Interhospital practice variation was measured using the median odds ratio. Over the study period, 6091 subjects from 45 hospitals were included. After adjusting for measurable covariates, discharge after 1/2016 was associated with increased odds of receiving digoxin (OR 3.9, p < 0.001). No association was seen between date of discharge and furosemide (p = 0.26) or aspirin (p = 0.12). Prior to 1/2016, the likelihood of receiving digoxin was decreasing (OR 0.9 per year, p < 0.001), while after 1/2016 the rate has increased (OR 1.4 per year, p < 0.001). However, there remains significant interhospital variation in the likelihood of receiving digoxin even after adjusting for known confounders (median odds ratio = 3.5, p < 0.0001). Following publication of studies describing an association between digoxin and improved interstage survival, the likelihood of receiving digoxin at discharge increased without similar changes for furosemide or aspirin. Despite concerted efforts to standardize interstage care, interhospital variation in pharmacotherapy in this vulnerable population persists.

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Data Availability

The data analyzed are proprietary and cannot be shared under the conditions of our data use agreement. Analytic code will be shared on request provided the requestor pledges that it will be used for academic purposes and appropriate citation is applied.

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Funding

Dr. O’Byrne (K23 HL130420-01) receives funding from the National Heart Lung and Blood Institute. The funding agency had no role in the planning or execution of the study, nor did they edit the manuscript as presented. The manuscript represents the opinions of the authors alone.

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Authors and Affiliations

  1. Division of Cardiology, The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Michael L. O’Byrne, Jing Huang, David J. Goldberg, Chitra Ravishankar, Jonathan J. Rome & Andrew C. Glatz

  2. Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Michael L. O’Byrne & Andrew C. Glatz

  3. Leonard Davis Institute and Center for Cardiovascular Outcomes, Quality, and Evaluative Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Michael L. O’Byrne

  4. Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Lihai Song & Jing Huang

  5. Department of Biostatistics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Jing Huang

  6. Division of Cardiac Critical Care, The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Monique M. Gardner

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  1. Michael L. O’Byrne
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  2. Lihai Song
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  3. Jing Huang
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  4. David J. Goldberg
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  6. Chitra Ravishankar
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  7. Jonathan J. Rome
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  8. Andrew C. Glatz
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Correspondence to Michael L. O’Byrne.

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The manuscript describes an analysis of a de-identified administrative dataset. The Institutional Review Board at our institution has ruled that all analyses from this database are exempt from review.

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O’Byrne, M.L., Song, L., Huang, J. et al. Trends in Discharge Prescription of Digoxin After Norwood Operation: An Analysis of Data from the Pediatric Health Information System (PHIS) Database. Pediatr Cardiol 42, 793–803 (2021). https://doi.org/10.1007/s00246-021-02543-y

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