Prevalent pharmacotherapy of US Fontan survivors: A study utilizing data from the MarketScan Commercial and Medicaid claims databases
Section snippets
Data source
The Truven Health MarketScan Claims and Encounter Database contains insurance claims data. For this project, modules containing data from both commercial insurers and Medicaid programs were used, as described previously.11., 12., 13., 14., 15., 16., 17., 18. This database provides in-depth, cross-sectional, and longitudinal patient-level data. Subjects are identified by both a longitudinal enrollee and plan identification number. Previous analyses using the same data set in which continuous
Study population
There were 4,056 children and adolescents included in the analysis of whom 39% were female (Table I). The median age was 12 years (interquartile range: 8-16 years), with 11% (n = 461) between the ages of 2 and 6 years, 40% (n = 1,626) between 7 and 12 years, and 49% (n = 1,969) between 13 and 19 years. Commercial insurance was used by 60% (n = 2,445) while 40% (n = 1,611) received Medicaid. Of the Medicaid recipients, 51% (n = 826) were white, 18% (n = 283) black, and 7% Hispanic (n = 105).
Distribution of pharmaceuticals
Discussion
In this retrospective observational study, the prevalent use of medications in children and adolescents after Fontan palliation was evaluated. Despite the risk of morbidity and mortality associated with the Fontan circulation, the slight majority of this cohort received no prescription cardiac medications. While older patients were more likely to be treated with medications used to treat systolic heart failure, antiarrhythmics, and anticoagulants, they were less likely to be treated with
Conclusion
The current study demonstrates the prevalent patterns of pharmaceutical utilization in children and adolescents after Fontan palliation. While the slight majority of subjects did not receive any cardiac drugs, there were differences in the odds of treatment with particular classes of medications in different age groups, suggesting a possible era effect in the approach to pharmaceutical regimens across the cohort. Understanding contemporary patterns of pharmaceutical use in patients who have
Funding
Dr. O'Byrne and Dr. Lemley received support from the National Institute of Health/National Heart Lung and Blood Institute (K23 HL130420-01 and T32-HL007915, respectively). The funding agencies had no role in the planning or execution of the study, nor did they edit the manuscript. The manuscript represents the opinions of the authors alone.
Conflict of interest
No relevant financial conflicts of interest to disclose.
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