Trends in Discharge Prescription of Digoxin After Norwood Operation: An Analysis of Data from the Pediatric Health Information System (PHIS) Database
- 2 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Pediatric Cardiology
- Vol. 42 (4), 793-803
- https://doi.org/10.1007/s00246-021-02543-y
Abstract
Quality improvement efforts have focused on reducing interstage mortality for infants with hypoplastic left heart syndrome (HLHS). In 1/2016, two publications reported that use of digoxin was associated with reduced interstage mortality. The degree to which these findings have affected real world practice has not been evaluated. The discharge medications of neonates with HLHS undergoing Norwood operation between 1/2007 and 12/2018 at Pediatric Health Information Systems Database hospitals were studied. Mixed effects models were calculated to evaluate the hypothesis that the likelihood of digoxin prescription increased after 1/2016, adjusting for measurable confounders with furosemide and aspirin prescription measured as falsification tests. Interhospital practice variation was measured using the median odds ratio. Over the study period, 6091 subjects from 45 hospitals were included. After adjusting for measurable covariates, discharge after 1/2016 was associated with increased odds of receiving digoxin (OR 3.9, p < 0.001). No association was seen between date of discharge and furosemide (p = 0.26) or aspirin (p = 0.12). Prior to 1/2016, the likelihood of receiving digoxin was decreasing (OR 0.9 per year, p < 0.001), while after 1/2016 the rate has increased (OR 1.4 per year, p < 0.001). However, there remains significant interhospital variation in the likelihood of receiving digoxin even after adjusting for known confounders (median odds ratio = 3.5, p < 0.0001). Following publication of studies describing an association between digoxin and improved interstage survival, the likelihood of receiving digoxin at discharge increased without similar changes for furosemide or aspirin. Despite concerted efforts to standardize interstage care, interhospital variation in pharmacotherapy in this vulnerable population persists.Keywords
Funding Information
- National Heart, Lung, and Blood Institute (HL130420-01)
This publication has 47 references indexed in Scilit:
- Impact of Pharmacotherapy on Interstage Mortality and Weight Gain in Children with Single VentricleCongenital Heart Disease, 2012
- Outcome and Resource Utilization of Infants Born With Hypoplastic Left Heart Syndrome in the Intermountain WestThe American Journal of Cardiology, 2012
- Use of surveillance criteria reduces interstage mortality after the Norwood operation for hypoplastic left heart syndromeEuropean Journal of Cardio-Thoracic Surgery, 2011
- The impact of a dedicated single-ventricle home-monitoring program on interstage somatic growth, interstage attrition, and 1-year survivalThe Journal of Thoracic and Cardiovascular Surgery, 2011
- Practice-Level Variation in Warfarin Use Among Outpatients With Atrial Fibrillation (from the NCDR PINNACLE Program)The American Journal of Cardiology, 2011
- Outcome of the Norwood operation in patients with hypoplastic left heart syndrome: A 12-year single-center surveyThe Journal of Thoracic and Cardiovascular Surgery, 2010
- Risk factors for interstage death after stage 1 reconstruction of hypoplastic left heart syndrome and variantsThe Journal of Thoracic and Cardiovascular Surgery, 2008
- Appropriate Assessment of Neighborhood Effects on Individual Health: Integrating Random and Fixed Effects in Multilevel Logistic RegressionAmerican Journal of Epidemiology, 2005
- Home surveillance program prevents interstage mortality after the Norwood procedureThe Journal of Thoracic and Cardiovascular Surgery, 2003
- Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysisJournal of Clinical Epidemiology, 1996