Guidelines for Drug Therapy in Pediatric Patients With Cardiovascular Diseases (JCS 2012)

Group, JCS Joint Working

doi:10.1253/circj.cj-66-0083

Cited by 15 publications

(4 citation statements)

References 61 publications

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“…Similar databases or handbooks exist in other countries. 14,15,[19][20][21][22][23] Our study indicated that the use of clinical support systems and local, national, and international guidelines was common in pediatric cardiology care, and that the use of off-label treatment without any shared evidence was rare. Our study encompassed many drugs (N = 65) and treatments (N = 233); it may be that a harmonization to a national protocol for drugs used in pediatric cardiac care, based on databases like ePed.se or sources in other countries, could be beneficial.…”

Section: Discussionmentioning

confidence: 99%

Evidence of support used for drug treatments in pediatric cardiology

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Wåhlander

Hanséus

et al. 2021

Health Science Reports

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Background and aims Clinical support systems are widely used in pediatric care. The aim of this study was to assess the support for drug treatments used at pediatric cardiac wards and intensive care units in Sweden. Methods Drug information, such as type of drug, indication, dose, and route of administration, for all in‐hospital pediatric cardiac patients, was included in the study. Treatments were classified as either on‐label (based on product information) or off‐label. Support for off‐label treatment was stratified by the use of clinical support systems (the national database on drugs, local, or other clinical experience guidelines). Results In all, 28 patients were included in the study. The total number of drug treatments was 233, encompassing 65 different drugs. Overall, 175 (75%) treatments were off‐label. A majority of off‐label drug treatments were supported by other sources of information shared by experts. A total of 7% of the drug treatments were used without support. Conclusion Off‐label drug treatment is still common in Swedish pediatric cardiac care. However, the majority of treatments were supported by the experience shared in clinical support systems. Key Points Seventy‐five percent of all prescriptions in pediatric cardiology care were off‐label. A majority of patients received three or more drug treatments off‐label. Use of clinical support systems and guidelines was common, but in 7% of all drug treatments, no support was found for the chosen treatment.

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Section: Discussionmentioning

confidence: 99%

Evidence of support used for drug treatments in pediatric cardiology

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Wåhlander

Hanséus

et al. 2021

Health Science Reports

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“…They should be above 55 years and have a history of CVD, systolic blood pressure ranging between 120 and 160 mmHg, LDL cholesterol <190 mg/dL, a glomerular filtration rate of at least 60 mL/min, less hepatic amino-transferase levels, normal potassium level, no contradictions to the polypill components, and using no more than two antihypertensive medications ( Muñoz et al, 2019 ; Castioni et al, 2021 ). However, the use of CVPs in children and pregnant women as a preventive therapy is not recommended as some of the drug compositions (such as ACE inhibitors, anti-hypertensive drugs, statins) are contraindicated for their use ( Alexander et al, 2009 ; JCS Joint Working Group, 2014 ; Kaelber et al, 2016 ; Mehta et al, 2020 ).…”

Section: Fdc In the Welfare Of Underprivileged Vulnerable Groupsmentioning

confidence: 99%

Redefining the polypill: pros and cons in cardiovascular precision medicine

Birla,

Angural,

Madathumchalil

et al. 2023

Front. Pharmacol.

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Polypill is a multi-drug formulation in a single pill intended to simplify the drug regimen and reduce medication-induced adverse effects. The most common multidrug combinations in a polypill are used to treat cardiovascular diseases and are targeted against key modifiable risk factors such as hypertension and hyperlipidemia. These contain blood-pressure lowering agents, statins, and anti-platelet agents usually in a fixed dose. Polypills can be an affordable therapeutic intervention for treating high-risk patients, as these are proven to increase patients’ adherence to medication and improve clinical outcomes. Over the previous years, randomized clinical trials of several polypills have yielded contradictory findings, raising skepticism regarding their widespread use in primary disease prevention. Here, we have reviewed the concept of polypills, the evidence-based strengths, the limitations of this polypharmacy intervention strategy, and discussed future directions for their use in the primary and secondary preventive management of cardiovascular diseases and associated risk factors.

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“…The average age of patients undergoing cardiac surgery is increasing, and they frequently have multiple comorbidities and concomitant frailty. Older, more frail patients, especially those with sarcopenia and comorbidities, are more likely to suffer significant functional decline, before, during and after hospitalisation for cardiac surgery [1,2].…”

Section: Introductionmentioning

confidence: 99%

A randomised controlled trial of prehabilitation in patients undergoing elective cardiac surgery

et al. 2023

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Summary The feasibility, safety and efficacy of prehabilitation in adult patients awaiting elective cardiac surgery are unknown. A total of 180 participants undergoing elective cardiac surgery were allocated randomly to receive either standard pre‐operative care or prehabilitation, consisting of pre‐operative exercise and inspiratory muscle training. The primary outcome was change in six‐minute walk test distance from baseline to pre‐operative assessment. Secondary outcomes included change in inspiratory muscle strength (maximal inspiratory pressure); sarcopenia (handgrip strength); quality of life and compliance. Safety outcomes were pre‐specified surgical and pulmonary complications and adverse events. All outcomes were assessed at baseline; at pre‐operative assessment; and 6 and 12 weeks following surgery. Mean (SD) age was 64.7 (10.2) years; 33/180 (18%) were women. In total, 65/91 (71.4%) participants who were allocated to prehabilitation attended at least four of eight supervised in‐hospital exercise classes; participants aged > 50 years were more likely than younger participants to attend (odds ratio (95%CI) of 4.6 (1.0–25.1)). Six‐minute walk test was not significantly different between groups (mean difference (95%CI) ‐7.8 m (‐30.6–15.0), p = 0.503) in the intention‐to‐treat analysis. Subgroup analyses based on tests for interaction indicated improvements in six‐minute walk test distance were larger amongst sarcopenic patients in the prehabilitation group (p = 0.004). Change in maximal inspiratory pressure from baseline to all time‐points was significantly greater in the prehabilitation group, with the greatest mean difference (95%CI) observed 12 weeks after surgery (10.6 cmH2O (4.6–16.6) cmH2O, p < 0.001). There were no differences in handgrip strength or quality of life up to 12 weeks after surgery. There was no significant difference in postoperative mortality (one death in each group), surgical or pulmonary complications. Of 71 pre‐operative adverse events, six (8.5%) were related to prehabilitation. The combination of exercise and inspiratory muscle training in a prehabilitation intervention before cardiac surgery was not superior to standard care in improving functional exercise capacity measured by six‐minute walk test distance pre‐operatively. Future trials should target patients living with sarcopenia and include inspiratory muscle strength training.

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Guidelines for Drug Therapy in Pediatric Patients With Cardiovascular Diseases (JCS 2012)

Cited by 15 publications

References 61 publications

Evidence of support used for drug treatments in pediatric cardiology

Evidence of support used for drug treatments in pediatric cardiology

Redefining the polypill: pros and cons in cardiovascular precision medicine

A randomised controlled trial of prehabilitation in patients undergoing elective cardiac surgery

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