Hostname: page-component-55f67697df-bzg56 Total loading time: 0 Render date: 2025-05-24T13:48:22.065Z Has data issue: false hasContentIssue false
  • English
  • Français

Prescription medication use after congenital heart surgery

Published online by Cambridge University Press:  06 January 2022

Alireza Raissadati Open the ORCID record for Alireza Raissadati [Opens in a new window] ,
Jari Haukka ,
Tommi Pätilä ,
Heta Nieminen  and
Eero Jokinen
Alireza Raissadati*
Affiliation:
Department of Surgery and Cardiology, New Children’s Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children’s Hospital, Palo Alto, California, USA
Jari Haukka
Affiliation:
Department of Public Health, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland Department of Health Sciences, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
Tommi Pätilä
Affiliation:
Department of Surgery and Cardiology, New Children’s Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
Heta Nieminen
Affiliation:
Department of Surgery and Cardiology, New Children’s Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
Eero Jokinen
Affiliation:
Department of Surgery and Cardiology, New Children’s Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
*
Author for correspondence: Alireza Raissadati, New Children’s Hospital, Stenbäckinkatu 9, Building 6, 00290 Helsinki, PO Box 281, Finland. Tel: +1 781-975-6250. E-mail: alireza.raissadati@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Improvements in mortality after congenital heart surgery have necessitated a shift in focus to postoperative morbidity as an outcome measure. We examined late morbidity after congenital heart surgery based on prescription medication use.

Methods:

Between 1953 and 2009, 10,635 patients underwent congenital heart surgery at <15 years of age in Finland. We obtained 4 age-, sex-, birth-time, and hospital district-matched controls per patient. The Social Insurance Institution of Finland provided data on all prescription medications obtained between 1999 and 2012 by patients and controls. Patients were assigned one diagnosis based on a hierarchical list of cardiac defects and dichotomised into simple and severe groups. Medications were divided into short- and long-term based on indication. Follow-up started at the first operation and ended at death, emigration, or 31 December, 2012.

Results:

Totally, 8623 patients met inclusion criteria. Follow-up was 99.9%. In total, 8126 (94%) patients required prescription medications. Systemic anti-bacterials were the most common short-term prescriptions among patients (93%) and controls (88%). Patients required betablockers (simple hazard ratio 1.9, 95% confidence interval 1.7–2.1; severe hazard ratio 6.5, 95% confidence interval 5.3–8.1) and diuretics (simple hazard ratio 3.2, 95% CI 2.8–3.7; severe hazard ratio 38.8, 95% CI 27.5–54.7) more often than the general population. Both simple and severe defects required medication for cardiovascular, gastrointestinal, psychiatric, neurologic, metabolic, autoimmune, and infectious diseases more often than the general population.

Conclusions:

The significant risk for postoperative cardiovascular and non-cardiovascular disease warrants close long-term follow-up after congenital heart surgery for all defects.

Keywords

CHDoutcomemorbidityepidemiologypaediatric cardiology
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 11 , November 2022 , pp. 1786 - 1793
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

McCracken, C, Spector, LG, Menk, JS, et al. Mortality following pediatric congenital heart surgery: an analysis of the causes of death derived from the national death index. J Am Heart Assoc 2018; 7.CrossRefGoogle ScholarPubMed
Raissadati, A, Nieminen, H, Haukka, J, Sairanen, H, Jokinen, E. Late causes of death after pediatric cardiac surgery. J Am Coll Cardiol 2016; 68:487–498.CrossRefGoogle ScholarPubMed
Raissadati, A, Nieminen, H, Jokinen, E, Sairanen, H. Progress in late results among pediatric cardiac surgery patients. Circulation 2015; 131: 347–353.CrossRefGoogle ScholarPubMed
Saha, P, Potiny, P, Rigdon, J, et al. Substantial cardiovascular morbidity in adults with lower-complexity congenital heart disease. Circulation 2019; 134: 101.Google Scholar
Landolt, MA, Valsangiacomo Buechel, ER, Latal, B. Health-related quality of life in children and adolescents after open-heart surgery. J Pediatr 2008; 152: 349–355.CrossRefGoogle ScholarPubMed
Moons, P, Van Deyk, K, De Bleser, L, et al. Quality of life and health status in adults with congenital heart disease: a direct comparison with healthy counterparts. Eur J Cardiovasc Prev Rehabil 2006; 13: 407–413.CrossRefGoogle ScholarPubMed
Overview of benefits programmes 2008. Statistical Yearbook of the Social Insurance Institution, Helsinki, Finland: Social Insurance Institution of Finland, Official Statistics of Finland 2009:26 & 336–75.Google Scholar
Nieminen, HP, Jokinen, EV, Sairanen, HI. Late results of pediatric cardiac surgery in Finland: a population-based study with 96% follow-up. Circulation 2001; 104: 570–575.CrossRefGoogle ScholarPubMed
Carlgren, LE, Ericson, A, Källén, B. Monitoring of congenital cardiac defects. Pediatr Cardiol 1987; 8: 247–256.CrossRefGoogle ScholarPubMed
Videbæk, J, Laursen, HB, Olsen, M, Høfsten, DE, Johnsen, SP. Long-term nationwide follow-up study of simple congenital heart disease diagnosed in otherwise healthy children. Circulation 2016; 133: 474–483.CrossRefGoogle ScholarPubMed
Madsen, NL, Marino, BS, Woo, JG, et al. Congenital heart disease with and without cyanotic potential and the long-term risk of diabetes mellitus: a population-based follow-up study. J Am Heart Assoc 2016; 5: 1.CrossRefGoogle ScholarPubMed
Sherwani, SI, Aldana, C, Usmani, S, et al. Intermittent hypoxia exacerbates pancreatic β-cell dysfunction in a mouse model of diabetes mellitus. Sleep 2013; 36: 1849–1858.CrossRefGoogle Scholar
Shustak, RJ, McGuire, SB, October, TW, Phoon, CKL, Chun, AJL. Prevalence of obesity among patients with congenital and acquired heart disease. Pediatr Cardiol 2011; 33: 8–14.CrossRefGoogle ScholarPubMed
Moola, F, Fusco, C, Kirsh, JA. The perceptions of caregivers toward physical activity and health in youth with congenital heart disease. Qual Health Res 2010; 21: 278–291.CrossRefGoogle ScholarPubMed
Pinto, NM, Marino, BS, Wernovsky, G, et al. Obesity is a common comorbidity in children with congenital and acquired heart disease. Pediatrics 2007; 120: 1157–1164.CrossRefGoogle ScholarPubMed
Pemberton, VL, McCrindle, BW, Barkin, S, et al. Report of the National Heart, Lung, and Blood Institute’s Working Group on obesity and other cardiovascular risk factors in congenital heart disease. Circulation 2010; 121: 1153–1159.CrossRefGoogle Scholar
Sonneville, KR, Rifas-Shiman, SL, Kleinman, KP, Gortmaker, SL, Gillman, MW, Taveras, EM. Associations of obesogenic behaviors in mothers and obese children participating in a randomized trial. Obesity 2012; 20: 1449–1454.CrossRefGoogle ScholarPubMed
Longmuir, PE, Brothers, JA, de Ferranti, SD, et al. Promotion of physical activity for children and adults with congenital heart disease: a scientific statement from the American Heart Association. Circulation 2013; 127: 2147–2159.CrossRefGoogle ScholarPubMed
Gurvitz, M, Ionescu-Ittu, R, Guo, L, et al. Prevalence of cancer in adults with congenital heart disease compared with the general population. Am J Cardiol 2016; 118: 1742–1750.CrossRefGoogle ScholarPubMed
Cohen, S, Liu, A, Gurvitz, M, et al. Exposure to low-dose ionizing radiation from cardiac procedures and malignancy risk in adults with congenital heart disease. Circulation 2018; 137: 1334–1345.CrossRefGoogle ScholarPubMed
Gudmundsdottir, J, Söderling, J, Berggren, H, et al. Long-term clinical effects of early thymectomy: Associations with autoimmune diseases, cancer, infections, and atopic diseases. J All Clin Immun 2018; 141: 2294–2298.CrossRefGoogle ScholarPubMed
Tulic, MK, Andrews, D, Crook, ML, et al. Changes in thymic regulatory T-cell maturation from birth to puberty: Differences in atopic children. J All Clin Immun 2012; 129: 199–206.CrossRefGoogle ScholarPubMed
Douek, DC, McFarland, RD, Keiser, PH, et al. Changes in thymic function with age and during the treatment of HIV infection. Nature 1998; 396: 690–695.CrossRefGoogle ScholarPubMed
Roosen, J, Oosterlinck, W, Meyns, B. Routine thymectomy in congenital cardiac surgery changes adaptive immunity without clinical relevance. Int Card Vasc Thorac Surg 2015; 20: 101–106.CrossRefGoogle ScholarPubMed
Freitas, IR, Castro, M, Sarmento, SL, et al. A cohort study on psychosocial adjustment and psychopathology in adolescents and young adults with congenital heart disease. BMJ Open 2013; 3: e001138.CrossRefGoogle Scholar
Pauliks, LB. Depression in adults with congenital heart disease-public health challenge in a rapidly expanding new patient population. World J Cardiol 2013; 5: 186–195.CrossRefGoogle Scholar
Fredriksen, PM, Mengshoel, AM, Frydenlund, A, Sørbye, Ø, Thaulow, E. Follow-up in patients with congenital cardiac disease more complex than haemodynamic assessment. Cardiol Young 2004; 14: 373–379.CrossRefGoogle ScholarPubMed
Marino, BS, Lipkin, PH, Newburger, JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association. Circulation 2012; 126: 1143–1172.CrossRefGoogle ScholarPubMed
Licht, DJ, Shera, DM, Clancy, RR, et al. Brain maturation is delayed in infants with complex congenital heart defects. J Thorac Cardiovasc Surg 2009; 137: 529–537.CrossRefGoogle ScholarPubMed
Miller, SP, McQuillen, PS, Hamrick, S, et al. Abnormal brain development in newborns with congenital heart disease. N Engl J Med 2007; 357: 1928–1938.CrossRefGoogle ScholarPubMed
Wilder, RT, Flick, RP, Sprung, J, et al. Early Exposure to Anesthesia and Learning Disabilities in a Population-based Birth Cohort. Anesthesiology 2009; 110: 796–804.CrossRefGoogle Scholar
Lichtman, JH, Bigger, JT Jr, Blumenthal, JA, et al. Depression and coronary heart disease. Circulation 2008; 118: 1768–1775.CrossRefGoogle ScholarPubMed
Raissadati, A, Knihtilä, H, Pätilä, T, et al. Long-term social outcomes after congenital heart surgery. Pediatrics 2020; 146.CrossRefGoogle ScholarPubMed
Supplementary material: Image

Raissadati et al. supplementary material

Raissadati et al. supplementary material 1

Download Raissadati et al. supplementary material(Image)
Image 2.9 MB
Supplementary material: Image

Raissadati et al. supplementary material

Raissadati et al. supplementary material 2

Download Raissadati et al. supplementary material(Image)
Image 4.9 MB