title: National prescribing trends for heart failure medications in children.
abstract: BACKGROUND
  The treatment of acute decompensated heart failure (ADHF) in adults has changed considerably over the past decade, and these changes have coincided with a reduction in inpatient mortality. At this time, national trends in medication prescribing among children hospitalized with ADHF are unknown.
  
  
  METHODS
  The Pediatric Health Information System (PHIS) database was queried to identify all patients ≤21 years of age who were admitted from 2001 to 2010 with ADHF and a diagnosis of cardiomyopathy. Patients were excluded for potential infectious or inflammatory etiologies of heart failure, congenital heart disease, cardiovascular surgery, acute heart transplant rejection, or isolated diastolic dysfunction. Only the index admission was used, and descriptive statistical methods were employed.
  
  
  RESULTS
  A total of 1773 patients (55.8% male) met study criteria (mortality 6.9%). Median length of stay was 9 days (IQR 4-16 days). Vasopressor or inotropic agents were used in 63.6% of patients (milrinone in 82.9% of these) and diuretics in 90.1% (furosemide in 98.4% of these). At discharge, a beta-blocker was prescribed in 36.8% of patients (carvedilol in 77.1% of these), and an angiotensin-converting enzyme (ACE) inhibitor was prescribed in 69.6% (enalapril in 59.9% of these). A wide variability in prescribing practices over time and by pediatric hospital was noted, along with a trend for decreased inotrope use and an increase in beta-blocker discharge prescribing.
  
  
  CONCLUSIONS
  This is the first national evaluation of prescribing trends in pediatric ADHF medication. A large degree of variability in medication use for ADHF and low rates of beta-blocker and ACE inhibitor use at discharge were identified.
authors.affiliation: Department of Pharmacy, Texas Children's Hospital, Houston, Tex, USA; Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex, USA.
authors.forename: Brady S
authors.initials: BS
authors.lastname: Moffett
authors.forename: Jack F
authors.initials: JF
authors.lastname: Price
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002309:Cardiology / Q000639:trends*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D006776:Hospitals, Pediatric / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000639:trends; D008297:Male; D010343:Patient Admission / Q000639:trends; D010351:Patient Discharge / Q000639:trends; D010372:Pediatrics / Q000639:trends*; D010607:Pharmacy Service, Hospital / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D002317:Cardiovascular Agents
keywords: Angiotensin-Converting Enzyme Inhibitor; Beta-Blockers; Discharge; Heart Failure; Inotrope; Pediatric