Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
Division of Pediatric Cardiology, University of Pittsburgh, Pittsburgh, PA, USA.
Pediatr Cardiol. 2021 Feb;42(2):315-323. doi: 10.1007/s00246-020-02485-x. Epub 2020 Oct 12.
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.
需要针对儿科人群的心力衰竭特定指标，才能成功为心力衰竭儿童实施质量改进计划。失代偿性心力衰竭入院后的出院时药物使用情况已被确定为该人群的潜在质量指标。本研究旨在报告当前时代因急性失代偿性心力衰竭入院的儿童的出院时药物使用情况。从儿科健康信息系统中确定了所有年龄<21 岁、索引入院（2011 年 1 月 1 日至 2019 年 12 月 31 日）为急性心力衰竭且并存心肌病诊断的患者。描述了药物使用模式，并按年龄组和中心进行了比较。共纳入 2288 例患者。在出院时，1479 例（64.6%）患者处方了血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（ACEi/ARB），1132 例（49.5%）患者处方了β受体阻滞剂，864 例（37.8%）患者处方了盐皮质激素受体拮抗剂（MRA）。与历史队列（2001-2010 年）相比，ACEi/ARB 的使用率随时间逐渐降低（64.6% vs. 69.6%，p=0.001），β受体阻滞剂的使用率逐渐升高（49.5% vs. 36.8%，p<0.001）。各中心的药物使用情况存在较大差异，随着时间的推移β受体阻滞剂的总体使用率增加，ACEi/ARB 的使用率降低。需要开展合作努力，以规范治疗并定义质量指标，从而确定儿科心力衰竭管理的最佳实践。
