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Pharmacotherapy in paediatric heart failure: a Delphi process

Published online by Cambridge University Press:  24 June 2019

Cristina C. Díez ,
Feras Khalil ,
Nina Makowski ,
Holger Schwender ,
Ida Jovanovic ,
Michiel Dalinghaus ,
Jennifer Walsh ,
Marijke van der Meulen ,
Milica Bajcetic  and
Saskia N. de Wildt
...Show all authors
Cristina C. Díez
Affiliation:
Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-University Düsseldorf, Germany
Feras Khalil
Affiliation:
Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-University Düsseldorf, Germany
Nina Makowski
Affiliation:
Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-University Düsseldorf, Germany
Holger Schwender
Affiliation:
Mathematical Institute, Heinrich-Heine-University Düsseldorf, Germany
Ida Jovanovic
Affiliation:
Department of Paediatric Cardiology, University Children’s Hospital, Belgrade, Serbia
Michiel Dalinghaus
Affiliation:
Department of Paediatric Cardiology, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
Jennifer Walsh
Affiliation:
Jenny Walsh Consulting Ltd, BioCity Nottingham, UK
Marijke van der Meulen
Affiliation:
Department of Paediatric Cardiology, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
Milica Bajcetic
Affiliation:
Department of Clinical Pharmacology, University Children’s Hospital, Belgrade, Serbia Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Serbia
Saskia N. de Wildt
Affiliation:
Department of Pharmacology and Toxicology, Radboud University, Nijmegen, The Netherlands Intensive Care and Department of Paediatric Surgery, Erasmus MC Sophia Children’s Hospital, Rotterdam, The Netherlands
Stephanie Läer*
Affiliation:
Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-University Düsseldorf, Germany
*
Author for correspondence: Prof. Dr Stephanie Läer, Heinrich-Heine-University Düsseldorf, Universitätsstraße 1, Gebäude 26.22, Ebene 02 Raum 24, 40225 Düsseldorf, Germany. Tel: +49 211 8110740; Fax: +49 211 8110741; E-mail: stephanie.laeer@uni-duesseldorf.de
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Abstract

Background:

Little evidence exists to support pharmacotherapeutic strategies for heart failure management in paediatrics. A recent Europe-wide survey suggests that this translates into substantial variability in clinical practice.

Objective:

To conduct a formal discussion among an expert group of paediatric cardiology physicians on controversial aspects regarding the pharmacotherapy of children heart failure, facilitate consensus, and highlight areas of agreement and disagreement.

Methods:

A two-round modified Delphi process was conducted between July and August 2015. Topics addressed were predominantly selected from the results of a previous Europe-wide survey. Fourteen statements were presented for discussion grouped under three categories; Angiotensin-converting-enzyme-inhibitors: Considerations for optimal dosage; Angiotensin-converting-enzyme-inhibitors for the management of CHDs; Neurohumoral antagonists for the management of dilated cardiomyopathy-related heart failure.

Results:

A total of 13 paediatricians dedicated to cardiology from across Europe and the United States of America completed the study; of them, 92% had a working experience in the field of more than 10 years and were working in a specific paediatric cardiology unit. Agreement on the acceptance/rejection of 11 statements was achieved. Results show agreement on the importance of a set of topics relevant to the standardisation of the therapy as well as consensus upon specific therapeutic attitudes.

Conclusions:

We have found areas of common thinking and motivation, which can provide a means of triggering scientific collaboration. Our results might also contribute to disseminate available paediatric evidence and promote reducing unjustified variability in everyday practice. Until solid evidence is available, other research methods can contribute to advancing the goal of safe and effective paediatric heart failure pharmacotherapy.

Keywords

Delphiheart failurepaediatricspharmacotherapyangiotensin-converting-enzyme-inhibitors
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 7 , July 2019 , pp. 869 - 876
Copyright
© Cambridge University Press 2019 

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Footnotes

*

Castro Díez C, Khalil F, Schwender H, Dalinghaus M, Jovanovic I, Makowski N, Male C, Bajcetic M, van der Meulen M, de Wildt SN., Ablonczy L, Szatmári A (†), Klingmann I, Walsh J, Läer S. Pharmacotherapeutic management of paediatric heart failure and ACE-I use patterns: a European survey. Published 31st January 2019 BMJ Paediatrics Open. Available from http://bmjpaedsopen.bmj.com/cgi/content/abstract/10.1136/bmjpo-2018-000365.

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