Abstract 13407: Trends in Discharge Prescription of Digoxin After Norwood Operation: An Analysis of Data From the Pediatric Health Information Systems Database (PHIS)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael L Obyrne ◽  
Lihai Song ◽  
JING HUANG ◽  
David J Goldberg ◽  
Monique A Gardner ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Practice Variation ◽  
Hypoplastic Left Heart ◽  
Large Magnitude ◽  
Hospital Variation ◽  
Significant Difference ◽  
Before And After ◽  
Interstage Mortality ◽  
Left Heart Syndrome ◽  
Discharge Prescription

Background: Quality improvement efforts have focused on reducing interstage mortality for infants with hypoplastic left heart syndrome (HLHS). In 2016 two publications reported that digoxin use was associated with reduced interstage mortality. The degree to which these findings have affected real world practice has not been evaluated. Methods: A multicenter retrospective cohort study of rates of digoxin prescription at discharge was performed of neonates with HLHS surviving to discharge without transplant from 1/2006-12/2018 at PHIS hospitals. A difference in difference analysis was performed using mixed effects models to adjust for measurable covariates (known arrhythmia, prematurity, renal insufficiency, etc.) with the hypothesis that the likelihood of digoxin prescription increased after 1/2016. Inter-hospital practice variation was measured, calculating the median odds ratio (MOR). Likelihood of furosemide and aspirin prescriptions were studied as falsification tests. Results: Over the study period 6091 subjects from 35 hospitals were included. Likelihood of receiving digoxin, furosemide, and aspirin are depicted (Figure). 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 likelihood has increased (OR: 2.4 per year, p<0.001). Significant inter-hospital variation in the likelihood of receiving digoxin was seen (MOR=3.5, p<0.001 with no significant difference before and after 2016). Conclusion: The use of digoxin increased after publication of data about potential benefit in the interstage period. However, despite concerted quality improvement efforts, there is persistent large magnitude inter-hospital variation in practice.

Echocardiographic evaluation before and after cardiac transplantation

2004 ◽  
Vol 14 (S1) ◽  
pp. 88-92 ◽  
Author(s):  
Alfred Asante-Korang
Keyword(s):  
Arterial Disease ◽  
Primary Treatment ◽  
Hypoplastic Left Heart ◽  
Viable Option ◽  
Coronary Arterial Disease ◽  
Echocardiographic Evaluation ◽  
Before And After ◽  
End Stage ◽  
Left Heart Syndrome ◽  
Transplantation Of The Heart

Transplantation of the heart remains a viable option not only as primary treatment for hypoplastic left heart syndrome, but also for end-stage problems after the Norwood sequence of palliations. In this review, I discuss the pre-operative, intra-operative, and post-operative echocardiographic evaluation of these patients, with special emphasis on hemodynamic and functional assessment as well as surveillance for rejection and coronary arterial disease.

scholarly journals Identified mortality risk factors associated with presentation, initial hospitalisation, and interstage period for the Norwood operation in a multi-centre registry: a report from the National Pediatric Cardiology-Quality Improvement Collaborative

2013 ◽  
Vol 24 (2) ◽  
pp. 253-262 ◽  
Author(s):  
Russell R. Cross ◽  
Ashraf S. Harahsheh ◽  
Robert McCarter ◽  
Gerard R. Martin ◽  
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Pediatric Cardiology ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Quality Improvement Collaborative ◽  
Interstage Mortality ◽  
Independent Risk Factors ◽  
Stage 1 ◽  
Left Heart Syndrome

AbstractIntroductionDespite improvements in care following Stage 1 palliation, interstage mortality remains substantial. The National Pediatric Cardiology-Quality Improvement Collaborative captures clinical process and outcome data on infants discharged into the interstage period after Stage 1. We sought to identify risk factors for interstage mortality using these data.Materials and methodsPatients who reached Stage 2 palliation or died in the interstage were included. The analysis was considered exploratory and hypothesis generating. Kaplan–Meier survival analysis was used to screen for univariate predictors, and Cox multiple regression modelling was used to identify potential independent risk factors.ResultsData on 247 patients who met the criteria between June, 2008 and June, 2011 were collected from 33 surgical centres. There were 23 interstage mortalities (9%). The identified independent risk factors of interstage mortality with associated relative risk were: hypoplastic left heart syndrome with aortic stenosis and mitral atresia (relative risk = 13), anti-seizure medications at discharge (relative risk = 12.5), earlier gestational age (relative risk = 11.1), nasogastric or nasojejunal feeding (relative risk = 5.5), unscheduled readmissions (relative risk = 5.3), hypoplastic left heart syndrome with aortic atresia and mitral stenosis (relative risk = 5.2), fewer clinic visits with primary cardiologist identified (relative risk = 3.1), and fewer post-operative vasoactive medications (relative risk = 2.2).ConclusionInterstage mortality remains substantial, and there are multiple potential risk factors. Future efforts should focus on further exploration of each risk factor, with potential integration of the factors into surveillance schemes and clinical practice strategies.

Limitations to survival for infants with hypoplastic left heart syndrome before and after transplant: The Loma Linda experience

1997 ◽  
Vol 7 (4) ◽  
pp. 180-186 ◽  
Author(s):  
Joyce Johnston ◽  
Richard Chinnock ◽  
Craig Zuppan ◽  
Anees Razzouk ◽  
Steven Gundry ◽  
...  
Keyword(s):  
Hypoplastic Left Heart Syndrome ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Before And After ◽  
Left Heart Syndrome

Variability of antithrombotics use in patients with hypoplastic left heart syndrome and its variants following first- and second-stage palliation surgery: a national report using the National Pediatric Cardiology Quality Improvement Collaborative registry

2016 ◽  
Vol 27 (4) ◽  
pp. 731-738 ◽  
Author(s):  
Preeti Ramachandran ◽  
Eileen King ◽  
Ashley Nebbia ◽  
Robert H. Beekman ◽  
Jeffrey B. Anderson
Keyword(s):  
Quality Improvement ◽  
Adverse Events ◽  
Pediatric Cardiology ◽  
Stage I ◽  
Stage Ii ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Quality Improvement Collaborative ◽  
Shunt Thrombosis ◽  
Left Heart Syndrome

AbstractPurposePatients with hypoplastic left heart syndrome and its variants following palliation surgery are at risk for thrombosis. This study examines variability of antithrombotic practice, the incidence of interstage shunt thrombosis, and other adverse events following Stage I and Stage II palliation within the National Pediatric Cardiology Quality Improvement Collaborative registry.MethodsWe carried out a multicentre, retrospective review using the National Pediatric Cardiology Quality Improvement Collaborative registry including patients from 2008 to 2013 across 52 surgical sites. Antithrombotic medications used at Stage I and Stage II discharge were evaluated. Variability of antithrombotics use at the individual patient level and intersite variability, incidence of shunt thrombosis, and other adverse events such as cardiac arrest, seizure, stroke, and need for cardiac catheterisation intervention in the interstage period were identified. Antithrombotic strategies for hybrid Stage I patients were evaluated but they were excluded from the variability and outcomes analysis.ResultsA total of 932 Stage I and 923 Stage II patients were included in the study: 93.8% of Stage I patients were discharged on aspirin and 4% were discharged on no antithrombotics, and 77% of Stage II patients were discharged on aspirin and 17.5% were discharged on no antithrombotics. Only three patients (0.2%) presented with interstage shunt thrombosis. The majority of patients who died during interstage or required shunt dilation and/or stenting were discharged home on aspirin.ConclusionAspirin is the most commonly used antithrombotic following Stage I and Stage II palliation. There is more variability in the choice of antithrombotics following Stage II compared with Stage I. The incidence of interstage shunt thrombosis and associated adverse events was rare.

Echocardiography of hypoplastic left heart syndrome

2011 ◽  
Vol 21 (S2) ◽  
pp. 28-37 ◽  
Author(s):  
Thieu Nguyen ◽  
Michelle Miller ◽  
Javier Gonzalez ◽  
Katherine Nardell ◽  
James Galas ◽  
...  
Keyword(s):  
Hypoplastic Left Heart Syndrome ◽  
Fontan Operation ◽  
Cardiac Monitoring ◽  
Left Heart ◽  
Norwood Operation ◽  
Hypoplastic Left Heart ◽  
Cavopulmonary Anastomosis ◽  
Operation Stage ◽  
Before And After ◽  
Left Heart Syndrome

AbstractEchocardiography is critical in the assessment of patients with hypoplastic left heart syndrome. Fundamental techniques and standardised approaches are useful when evaluating patients with hypoplastic left heart syndrome prenatally, after birth, and before the Norwood operation (Stage 1); after the Norwood operation, before and after the superior cavopulmonary anastomosis (Stage 2); before and after the Fontan operation (Stage 3); and for chronic surveillance after the Fontan operation. From foetal assessment to ongoing surveillance after the Fontan procedure, echocardiography remains the primary technique for cardiac monitoring in this growing population of children and adults.

Sign in / Sign up

Export Citation Format

Share Document