美国 Fontan 幸存者的普遍药物治疗：一项利用 MarketScan 商业和医疗补助索赔数据库数据的研究。
Prevalent pharmacotherapy of US Fontan survivors: A study utilizing data from the MarketScan Commercial and Medicaid claims databases.
机构信息
Division of Cardiology, Department of Pediatrics, the Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Center for Pediatric Clinical Effectiveness at The Children's Hospital of Philadelphia, Philadelphia, PA; Leonard Davis Institute and Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, PA.
Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, The Children's Hospital of Philadelphia, Philadelphia, PA.
出版信息
Am Heart J. 2022 Jan;243:158-166. doi: 10.1016/j.ahj.2021.09.012. Epub 2021 Sep 25.
BACKGROUND
Survivors of Fontan palliation are at life-long risk of thrombosis, arrhythmia, and circulatory failure. To our knowledge, no studies have evaluated current United States pharmaceutical prescription practice in this population.
METHODS
A retrospective observational study evaluating the prevalent use of prescription medications in children and adolescents with hypoplastic left heart syndrome or tricuspid atresia after Fontan completion (identified using ICD9/10 codes) was performed using data contained in the MarketScan Commercial and Medicaid databases for the years 2013 through 2018. Cardiac pharmaceuticals were divided by class. Anticoagulant agents other than platelet inhibitors, which are not uniformly a prescription medication, were also studied. Associations between increasing age and the likelihood of a filled prescription for each class of drug were evaluated. Annualized retail costs of pharmaceutical regimens were calculated.
RESULTS
A cohort of 4,056 subjects (median age 12 years [interquartile range: 8-16], 61% male, 60% commercial insurance) was identified. Of the cohort, 50% received no prescription medications. Angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) (38%), diuretics (15%), and mineralocorticoid receptor antagonists (8%) were prescribed with the highest frequency. Pulmonary vasodilators were received by 6% of subjects. Older age was associated with increased likelihood of filled prescriptions for anticoagulants (P = .008), antiarrhythmic agents, digoxin, ACEi/ARB, and beta blockers (each P < .0001), but also lower likelihood of filled prescriptions for pulmonary vasodilators, conventional diuretics (both P < .0001), and mineralocorticoid receptor antagonists (P = .02).
CONCLUSIONS
Pharmaceuticals typically used to treat heart failure and pulmonary hypertension are the most commonly prescribed medications following Fontan palliation. While the likelihood of treatment with a particular class of medication is associated with the age of the patient, determining the optimal regimen for individual patients and the population at large is an important knowledge gap for future research.
背景
Fontan 姑息术后患者终身面临血栓形成、心律失常和循环衰竭的风险。据我们所知，目前还没有研究评估美国在该人群中使用的药物处方实践。
方法
使用 2013 年至 2018 年 MarketScan 商业和医疗补助数据库中包含的数据，进行了一项回顾性观察性研究，评估了 Fontan 完成后患有左心发育不全综合征或三尖瓣闭锁的儿童和青少年中常见的处方药物使用情况（通过 ICD9/10 代码识别）。将心脏药物分为不同类别。还研究了不是统一处方药物的血小板抑制剂以外的抗凝药物。评估了每个药物类别与年龄增加之间的关系。计算了药物治疗方案的年化零售成本。
结果
确定了一个 4056 名患者的队列（中位数年龄 12 岁[四分位距：8-16]，61%为男性，60%为商业保险）。该队列中有 50%的患者未接受任何处方药物治疗。血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEi/ARB）（38%）、利尿剂（15%）和盐皮质激素受体拮抗剂（8%）的处方频率最高。6%的患者接受了肺动脉扩张剂。年龄较大与抗凝剂（P=0.008）、抗心律失常药、地高辛、ACEi/ARB 和β受体阻滞剂（均 P<0.0001）的处方可能性增加相关，但与肺动脉扩张剂、传统利尿剂（均 P<0.0001）和盐皮质激素受体拮抗剂（P=0.02）的处方可能性降低相关。
结论
常用于治疗心力衰竭和肺动脉高压的药物是 Fontan 姑息术后最常开的药物。虽然特定类别的药物治疗可能性与患者年龄有关，但为个别患者和整个人群确定最佳治疗方案是未来研究的一个重要知识空白。
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