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Variability in Treatment of Post-coarctectomy Hypertension: A Multicenter Study.
Pediatr Cardiol. 2016 Apr; 37(4):772-7.PC

Abstract

Many pharmacologic therapies are available for treatment of post-coarctectomy hypertension in pediatric patients, which may lead to variability in care. Evaluation of trends in pharmacotherapy is necessary to evaluate quality of care. The Pediatric Health Information System database was queried from 2004 to 2013 for patients >30 days of age who had an ICD-9 code for coarctation of the aorta repair of coarctation by end-to-end anastomosis and had a RACHS-1 score of 2. Patients were excluded if they were admitted for >30 days, underwent mechanical circulatory support, or expired during the admission. Patient demographic and hospital data were collected along with antihypertensive pharmacotherapy. Trends in antihypertensive, analgesic, and sedative pharmacotherapy were evaluated, and multivariable statistical analysis was used to determine variables that significantly influenced cost. A total of 1636 patients [66.6 % male, median age 1.5 years (IQR 0.31-5.3)] met study criteria. Patients received a median of 3 (IQR 2-4) antihypertensive medications for a median of 8 days (IQR 5-11). Intravenous antihypertensive therapy was prescribed for a median 3 days (IQR 2-5) and oral therapy for a median of 1 day (IQR 1-2). Antihypertensive therapy was continued at discharge in 79.8 % of patients. Hospital cost increased by 36 % over the study period (p < 0.01), and nicardipine, dexmedetomidine, and intravenous acetaminophen were most strongly associated with increased cost (p < 0.001). Variability in the pharmacotherapy of post-coarctectomy hypertension in pediatric patients exists, and the use of newer agents may be influencing the cost of care.

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Authors+Show Affiliations

Moffett BS
Department of Pharmacy, Texas Children's Hospital, 6621 Fannin Street, Suite WB1120, Houston, TX, 77030, USA. bsmoffet@texaschildrens.org. Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. bsmoffet@texaschildrens.org.
Penny DJ
Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.

MeSH

Antihypertensive AgentsAortic CoarctationChild, PreschoolDatabases, FactualFemaleHospital CostsHumansHypertensionInfantLength of StayMaleMultivariate AnalysisPatient DischargePostoperative ComplicationsRetrospective StudiesUnited StatesVascular Surgical Procedures

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

26897371

Citation

Moffett, Brady S., and Daniel J. Penny. "Variability in Treatment of Post-coarctectomy Hypertension: a Multicenter Study." Pediatric Cardiology, vol. 37, no. 4, 2016, pp. 772-7.
Moffett BS, Penny DJ. Variability in Treatment of Post-coarctectomy Hypertension: A Multicenter Study. Pediatr Cardiol. 2016;37(4):772-7.
Moffett, B. S., & Penny, D. J. (2016). Variability in Treatment of Post-coarctectomy Hypertension: A Multicenter Study. Pediatric Cardiology, 37(4), 772-7. https://doi.org/10.1007/s00246-016-1349-z
Moffett BS, Penny DJ. Variability in Treatment of Post-coarctectomy Hypertension: a Multicenter Study. Pediatr Cardiol. 2016;37(4):772-7. PubMed PMID: 26897371.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Variability in Treatment of Post-coarctectomy Hypertension: A Multicenter Study. AU - Moffett,Brady S, AU - Penny,Daniel J, Y1 - 2016/02/20/ PY - 2015/09/11/received PY - 2016/02/04/accepted PY - 2016/2/22/entrez PY - 2016/2/22/pubmed PY - 2017/2/1/medline KW - Antihypertensive medications KW - Coarctation KW - Hypertension KW - Repair SP - 772 EP - 7 JF - Pediatric cardiology JO - Pediatr Cardiol VL - 37 IS - 4 N2 - Many pharmacologic therapies are available for treatment of post-coarctectomy hypertension in pediatric patients, which may lead to variability in care. Evaluation of trends in pharmacotherapy is necessary to evaluate quality of care. The Pediatric Health Information System database was queried from 2004 to 2013 for patients >30 days of age who had an ICD-9 code for coarctation of the aorta repair of coarctation by end-to-end anastomosis and had a RACHS-1 score of 2. Patients were excluded if they were admitted for >30 days, underwent mechanical circulatory support, or expired during the admission. Patient demographic and hospital data were collected along with antihypertensive pharmacotherapy. Trends in antihypertensive, analgesic, and sedative pharmacotherapy were evaluated, and multivariable statistical analysis was used to determine variables that significantly influenced cost. A total of 1636 patients [66.6 % male, median age 1.5 years (IQR 0.31-5.3)] met study criteria. Patients received a median of 3 (IQR 2-4) antihypertensive medications for a median of 8 days (IQR 5-11). Intravenous antihypertensive therapy was prescribed for a median 3 days (IQR 2-5) and oral therapy for a median of 1 day (IQR 1-2). Antihypertensive therapy was continued at discharge in 79.8 % of patients. Hospital cost increased by 36 % over the study period (p < 0.01), and nicardipine, dexmedetomidine, and intravenous acetaminophen were most strongly associated with increased cost (p < 0.001). Variability in the pharmacotherapy of post-coarctectomy hypertension in pediatric patients exists, and the use of newer agents may be influencing the cost of care. SN - 1432-1971 UR - https://www.unboundmedicine.com/medline/citation/26897371/Variability_in_Treatment_of_Post_coarctectomy_Hypertension:_A_Multicenter_Study_ DB - PRIME DP - Unbound Medicine ER -