An increasingly high medication burden plagues children who undergo cardiac surgery, a new analysis shows.
These data were reported by Joyce L. Woo, MD, MS, of the Northwestern University Feinberg School of Medicine, Chicago, and colleagues, in a manuscript published Monday online and in the Sept. 26 issue of the Journal of the American College of Cardiology.
Roughly 1% of live births produce children with congenital heart defects, despite a decrease in overall mortality rates for children with heart defects over time. Children who undergo cardiac surgery often have longitudinal burdens, and chronic use of medication is one measurement of disease burden used to determine overall healthcare utilization and expenditures.
This study investigated outpatient prescription medication use and expenditures for children enrolled in New York state pediatric Medicaid. Children who underwent cardiac surgery were compared with children in the general pediatric population. This retrospective cohort study utilized the New York State Heart Surgery Collaborative for Longitudinal Outcomes and Utilization of Resources database, between 2006 and 2019, to evaluate all Medicaid enrollees under 18 years of age.
The primary outcomes of this study included total chronic medications per person-year, children per 100 person-years using ≥1 and ≥3 medications and medication expenditures per person-year. Outcome differences were examined between children who underwent cardiac surgery, referred to as “cardiac enrollees,” and the general pediatric population. Associations between outcomes and clinical characteristics were analyzed using multivariable regression.
A total of 5,459 children (32,131 person-years; 45.4% female; 19.5% Hispanic, 18.7% Non-Hispanic Black, 30.9% Non-Hispanic white) who underwent cardiac surgery and 4.5 million children (22 million person-years; 48.7% female; 16.9% Hispanic, 19.6% Non-Hispanic Black, 25.8% Non-Hispanic white) who did not undergo cardiac surgery were included in the study.
More than 4 in 10 children in the cardiac surgery cohort were using ≥1 chronic medication, whereas 1 in 10 children in the non-cardiac surgery group used ≥1 chronic medication. Cardiac enrollees incurred medication expenditures 10 times higher per person-year than children who were not cardiac enrollees. Chronic medication use was associated with disease severity in cardiac enrollees, and chronic medication use was highest in infants. Roughly 50% of adolescent cardiac enrollees were taking ≥1 chronic medication.
Some limitations of this study included that the investigators used filled prescriptions and refills as proxies for medication usage. There could be potential bias in the connection between filled prescriptions and use of the medication. In addition, out-of-pocket expenses were not included in the medication expenditures analysis. Finally, the results may not be generalizable to uninsured children or children outside New York.
Overall, there is a high medication burden on children who undergo cardiac surgery. Understanding this burden, along with chronic medication expenditures, may better inform policies directed toward improving the value of care.
In an accompanying editorial, Mary B. Taylor, MD, MSCI, of the University of Mississippi Medical Center, Jackson, described the societal impacts of congenital heart defects and the importance of understanding the best management strategies for children with cardiac problems.
“Understanding the impact of chronic medication usage is important for providers, not only to better care for their individual patients but also to better understand the broader impact on this population,” she wrote.
The editorialist highlighted the study’s finding that the observed differences in chronic medication use between cardiac and non-cardiac pediatric patients continued throughout childhood despite disease severity, as well as the social challenges families face when caring for a child taking chronic medications.
“This paper emphasizes that pediatricians and subspecialists should continuously weigh the psychological burden and potential risks associated with prescribing ‘yet another’ chronic medication. Because more children with congenital heart anomalies are now living to adulthood, this report is even more impactful than ever,” she concluded.
Woo JL, Nash KA, Dragan K, et al. Chronic Medication Burden After Cardiac Surgery for Pediatric Medicaid Beneficiaries. J Am Coll Cardiol. 2023;82:1331-1340.
Taylor MB. The Burden of Chronic Medication in Congenital Heart Disease Matters. J Am Coll Cardiol. 2023;82:1341-1342.
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