Evidence of support used for drug treatments in pediatric cardiology

Abstract 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

Cardiovascular imaging in children and adults following Kawasaki disease

Kawasaki disease (KD) is a paediatric vasculitis with coronary artery aneurysms (CAA) as its main complication. Two guidelines exist regarding the follow-up of patients after KD, by the American Heart Association and the Japanese Circulation Society. After the acute phase, CAA-negative patients are checked for cardiovascular risk assessment or with ECG and echocardiography until 5 years after the disease. In CAA-positive patients, monitoring includes myocardial perfusion imaging, conventional angiography and CT-angiography. However, the invasive nature and high radiation exposure do not reflect technical advances in cardiovascular imaging. Newer techniques, such as cardiac MRI, are mentioned but not directly implemented in the follow-up. Cardiac MRI can be performed to identify CAA, but also evaluate functional abnormalities, ischemia and previous myocardial infarction including adenosine stress-testing. Low-dose CT angiography can be implemented at a young age when MRI without anaesthesia is not feasible. CT calcium scoring with a very low radiation dose can be useful in risk stratification years after the disease. By incorporating newer imaging techniques, detection of CAA will be improved while reducing radiation burden and potential complications of invasive imaging modalities. Based on the current knowledge, a possible pathway to follow-up patients after KD is introduced. Key Points • Kawasaki disease is a paediatric vasculitis with coronary aneurysms as major complication. • Current guidelines include invasive, high-radiation modalities not reflecting new technical advances. • Cardiac MRI can provide information on coronary anatomy as well as cardiac function. • (Low-dose) CT-angiography and CT calcium score can also provide important information. • Current guidelines for follow-up of patients with KD need to be revised