Chronic Medication Burden After Cardiac Surgery for Pediatric Medicaid Beneficiaries.

Autor:	Woo JL; Division of Pediatric Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA., Nash KA; Division of Pediatric Critical Care and Hospital Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA., Dragan K; Wagner Graduate School of Public Service, New York University, New York, New York, USA; Interfaculty Initiative in Health Policy, Graduate School of Arts and Sciences, Harvard University, Boston, Massachusetts, USA., Crook S; Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA., Neidell M; Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, USA., Cook S; New York State Department of Health; Offices of Health Insurance Programs, Albany, New York, USA; Department of Pediatrics, Internal Medicine, and Center for Community Health, University of Rochester Medical Center, Rochester, New York, USA., Hannan EL; University at Albany School of Public Health, Rensselaer, New York, USA., Jacobs M; Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Goldstone AB; Department of Cardiothoracic Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center and Weill Cornell Medical Center, New York, New York, USA., Petit CJ; Interfaculty Initiative in Health Policy, Graduate School of Arts and Sciences, Harvard University, Boston, Massachusetts, USA., Vincent R; Division of Pediatric Cardiology, Westchester Medical Center, Valhalla, New York, USA., Walsh-Spoonhower K; Division of Pediatric Cardiology, Stony Brook Children's Hospital, Stony Brook, New York, USA., Mosca R; Department of Cardiothoracic Surgery, New York University, New York, New York, USA., Kumar TKS; Department of Cardiothoracic Surgery, New York University, New York, New York, USA., Devejian N; Division of Pediatric Cardiothoracic Surgery, Albany Medical College, Albany, New York, USA., Kamenir SA; Division of Pediatric Cardiology, Albany Medical College, Albany, New York, USA., Alfieris GM; Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York, USA; Department of Surgery, State University of New York Upstate Medical Center, Syracuse, New York, USA., Swartz MF; Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York, USA., Meyer D; Departments of Cardiothoracic Surgery and Pediatrics, Hofstra-Northwell School of Medicine, Uniondale, New York, USA., Paul EA; Division of Pediatric Cardiology, Icahn School of Medicine at Mt Sinai, New York, New York, USA., Newburger JW; Department of Pediatric Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA., Billings J; Division of Pediatric Critical Care and Hospital Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA., Davis MM; Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Anderson BR; Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA. Electronic address: bra2113@cumc.columbia.edu.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Cardiology [J Am Coll Cardiol] 2023 Sep 26; Vol. 82 (13), pp. 1331-1340.
DOI:	10.1016/j.jacc.2023.06.046
Abstrakt:	Background: Congenital heart defects are the most common and resource-intensive birth defects. As children with congenital heart defects increasingly survive beyond early childhood, it is imperative to understand longitudinal disease burden. Objectives: The purpose of this study was to examine chronic outpatient prescription medication use and expenditures for New York State pediatric Medicaid enrollees, comparing children who undergo cardiac surgery (cardiac enrollees) and the general pediatric population. Methods: This was a retrospective cohort study of all Medicaid enrollees age <18 years using the New York State Congenital Heart Surgery Collaborative for Longitudinal Outcomes and Utilization of Resources database (2006-2019). Primary outcomes were total chronic medications per person-year, enrollees per 100 person-years using ≥1 and ≥3 medications, and medication expenditures per person-year. We described and compared outcomes between cardiac enrollees and the general pediatric population. Among cardiac enrollees, multivariable regression examined associations between outcomes and clinical characteristics. Results: We included 5,459 unique children (32,131 person-years) who underwent cardiac surgery and 4.5 million children (22 million person-years) who did not. More than 4 in 10 children who underwent cardiac surgery used ≥1 chronic medication compared with approximately 1 in 10 children who did not have cardiac surgery. Medication expenditures were 10 times higher per person-year for cardiac compared with noncardiac enrollees. Among cardiac enrollees, disease severity was associated with chronic medication use; use was highest among infants; however, nearly one-half of adolescents used ≥1 chronic medication. Conclusions: Children who undergo cardiac surgery experience high medication burden that persists throughout childhood. Understanding chronic medication use can inform clinicians (both pediatricians and subspecialists) and policymakers, and ultimately the value of care for this medically complex population. Competing Interests: Funding Support and Author Disclosures This study is funded by the National Heart, Lung, and Blood Institute (NIH/NHLBI R01 HL150044, to principal investigator Dr Anderson). The views and opinions expressed in this paper are those of the authors and do not necessarily reflect the official policy or position of the National Institutes of Health, the Agency of Healthcare Research and Quality, or the New York State Department of Health. Examples of analysis performed within this article are only examples. They should not be utilized in real-world analytic products. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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