Establishing Baseline Metrics of Heart Failure Medication Use in Children: A Collaborative Effort from the ACTION Network.
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.
['Stidham|Joseph|J|', 'Feingold|Brian|B|', 'Almond|Christopher S|CS|', 'Burstein|Danielle S|DS|', 'Krack|Paige|P|', 'Price|Jack F|JF|', 'Schumacher|Kurt R|KR|', 'Spinner|Joseph A|JA|', 'Rosenthal|David N|DN|', 'Lorts|Angela|A|', 'Godown|Justin|J|http://orcid.org/0000-0002-7068-0625']
D000293:Adolescent D000319:Adrenergic beta-Antagonists D057911:Angiotensin Receptor Antagonists D000806:Angiotensin-Converting Enzyme Inhibitors D019985:Benchmarking D009202:Cardiomyopathies D002317:Cardiovascular Agents D002648:Child D002675:Child, Preschool D005260:Female D006333:Heart Failure D006760:Hospitalization D006801:Humans D008297:Male D000451:Mineralocorticoid Receptor Antagonists D010351:Patient Discharge D010818:Practice Patterns, Physicians' D011788:Quality of Life D055815:Young Adult
Heart failure Medication Pediatric Quality improvement