RT Journal Article
SR Electronic
T1 Pharmacotherapeutic management of paediatric heart failure and ACE-I use patterns: a European survey
JF BMJ Paediatrics Open
FD BMJ Publishing Group Ltd
SP e000365
DO 10.1136/bmjpo-2018-000365
VO 3
IS 1
A1 Cristina Castro Díez
A1 Feras Khalil
A1 Holger Schwender
A1 Michiel Dalinghaus
A1 Ida Jovanovic
A1 Nina Makowski
A1 Christoph Male
A1 Milica Bajcetic
A1 Marijke van der Meulen
A1 Saskia N de Wildt
A1 László Ablonczy
A1 András Szatmári
A1 Ingrid Klingmann
A1 Jennifer Walsh
A1 Stephanie Läer
YR 2019
UL http://bmjpaedsopen.bmj.com/content/3/1/e000365.abstract
AB Objective To characterise heart failure (HF) maintenance pharmacotherapy for children across Europe and investigate how angiotensin-converting enzyme inhibitors (ACE-I) are used in this setting.Methods A Europe-wide web-based survey was conducted between January and May 2015 among European paediatricians dedicated to cardiology.Results Out of 200-eligible, 100 physicians representing 100 hospitals in 27 European countries participated. All participants reported prescribing ACE-I to treat dilated cardiomyopathy-related HF and 97% in the context of congenital heart defects; 87% for single ventricle physiology. Twenty-six per cent avoid ACE-I in newborns. Captopril was most frequently selected as first-choice for newborns (73%) and infants and toddlers (66%) and enalapril for children (56%) and adolescents (58%). Reported starting and maintenance doses varied widely. Up to 72% of participants follow formal creatinine increase limits for decision-making when up-titrating; however, heterogeneity in the cut-off points selected existed. ACE-I formulations prescribed by 47% of participants are obtained from more than a single source. Regarding symptomatic HF maintenance therapy, 25 different initial drug combinations were reported, although 79% select a regimen that includes ACE-I and diuretic (thiazide and/or loop), 61% ACE-I and aldosterone antagonist; 44% start with beta-blocker, 52% use beta-blockers as an add-on drug. Of the 89 participants that prescribe pharmacotherapy to asymptomatic patients, 40% do not use ACE-I monotherapy or ACE-I-beta-blocker two-drug only combination.Conclusions Despite some reluctance to use them in newborns, ACE-I seem key in paediatric HF treatment strategies. Use in single ventricle patients seems frequent, in apparent contradiction with current paediatric evidence. Disparate dosage criteria and potential formulation-induced variability suggest significant differences may exist in the risk-benefit profile children are exposed to. No uniformity seems to exist in the drug regimens in use. The information collected provides relevant insight into real-life clinical practice and may facilitate research to identify the best therapeutic options for HF children.