Outpatient drug therapy for children with heart disease in Switzerland: a survey.
Cardiovascular drug therapy in adults is steadily progressing. However, the extent to which children with heart disease in Switzerland benefit from this progress remains unknown. This survey aimed to investigate the current outpatient prescribing practices among paediatric cardiologists in Switzerland. We conducted a cross-sectional survey among Swiss paediatric cardiologists. The physicians were asked to state how often they administer drugs on a pre-defined list for the following indications: heart failure, arrhythmia and thromboembolism. Forty-three (56%) out of 77 eligible physicians completed the survey. For paediatric heart failure, the three most frequently prescribed drugs were hydrochlorothiazide ('often prescribed' by n = 25, 58%), lisinopril (n = 24, 56%), and spironolactone (n = 32, 74%). The most frequently prescribed drugs for arrhythmia and thromboembolism were propranolol (n = 26, 60%) and acetylsalicylic acid (n = 31, 72%), respectively. Newer drugs such as sacubitril/valsartan ('never prescribed' by n = 20, 47%), sodium-glucose cotransporter type 2 inhibitors (n = 40, 93%), and direct oral anticoagulants (n = 20, 47%) were rarely used.
The drugs used to treat heart failure, arrhythmia, and thromboembolism in Switzerland largely reflect current international recommendations. Nevertheless, novel drugs are rarely used. In addition to the lack of large randomized controlled drug trials in children, important obstacles are lack of authorization, lack of reimbursement, and lack of suitable formulations. These issues should be addressed by both the industry and healthcare providers to continuously improve drug therapy for children with heart disease.
• Evidence for drug use in Paediatric cardiology mostly relies on extrapolation from adult studies and pathophysiological considerations. • Drug choices are also influenced by drug approval, insurance reimbursement, and availability of age-appropriate formulations.
• Swiss paediatric cardiologists predominantly rely on established drugs to treat cardiovascular diseases in children, with the use of newer drugs remaining limited. • On top of expert consensus, adult evidence, and drug availability, drug prescription appears to be strongly influenced by the availability of child-friendly formulations.
The drugs used to treat heart failure, arrhythmia, and thromboembolism in Switzerland largely reflect current international recommendations. Nevertheless, novel drugs are rarely used. In addition to the lack of large randomized controlled drug trials in children, important obstacles are lack of authorization, lack of reimbursement, and lack of suitable formulations. These issues should be addressed by both the industry and healthcare providers to continuously improve drug therapy for children with heart disease.
• Evidence for drug use in Paediatric cardiology mostly relies on extrapolation from adult studies and pathophysiological considerations. • Drug choices are also influenced by drug approval, insurance reimbursement, and availability of age-appropriate formulations.
• Swiss paediatric cardiologists predominantly rely on established drugs to treat cardiovascular diseases in children, with the use of newer drugs remaining limited. • On top of expert consensus, adult evidence, and drug availability, drug prescription appears to be strongly influenced by the availability of child-friendly formulations.
Authors
BĂ€rlocher BĂ€rlocher, Caduff Good Caduff Good, Di Bernardo Di Bernardo, Lava Lava, Stambach Stambach, Tissot Tissot, Knirsch Knirsch, Wacker Wacker, Cavigelli-Brunner Cavigelli-Brunner, Bosch Bosch, Balmer Balmer
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