Establishing Baseline Metrics of Heart Failure Medication Use in Children: A Collaborative Effort from the ACTION Network

Pediatr Cardiol. 2021 Feb;42(2):315-323. doi: 10.1007/s00246-020-02485-x. Epub 2020 Oct 12.


Heart failure metrics specific to the pediatric population are required to successfully implement quality improvement initiatives in children with heart failure. Medication use at the time of discharge following admission for decompensated heart failure has been identified as a potential quality metric in this population. This study aimed to report medication use at discharge in the current era for children admitted with acute decompensated heart failure. All patients < 21 years of age with an index admission (1/1/2011-12/31/2019) for acute heart failure and a coexisting diagnosis of cardiomyopathy were identified from the Pediatric Health Information System. Medication use patterns were described and compared across age groups and centers. A total of 2288 patients were identified for inclusion. An angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker (ACEi/ARB) was prescribed in 1479 (64.6%), beta blocker in 1132 (49.5%), and mineralocorticoid receptor antagonist (MRA) in 864 (37.8%) patients at discharge. The use of ACEi/ARB at discharge has decreased over time (64.6% vs. 69.6%, p = 0.001) and the use of beta blockers has increased (49.5% vs. 36.8%, p < 0.001) compared to a historical cohort (2001-2010). There is considerable variability in medication use across centers with an overall increase in beta blocker and decrease in ACEi/ARB use over time. Collaborative efforts are needed to standardize care and define quality metrics to identify best practices in the management of pediatric heart failure.

Keywords: Heart failure; Medication; Pediatric; Quality improvement.

MeSH terms

  • Adolescent
  • Adrenergic beta-Antagonists / therapeutic use*
  • Angiotensin Receptor Antagonists / therapeutic use*
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Benchmarking
  • Cardiomyopathies / epidemiology
  • Cardiovascular Agents / therapeutic use
  • Child
  • Child, Preschool
  • Female
  • Heart Failure / drug therapy*
  • Heart Failure / epidemiology
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Mineralocorticoid Receptor Antagonists / therapeutic use*
  • Patient Discharge / statistics & numerical data
  • Practice Patterns, Physicians' / statistics & numerical data
  • Quality of Life
  • Young Adult


  • Adrenergic beta-Antagonists
  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Cardiovascular Agents
  • Mineralocorticoid Receptor Antagonists