Pharmacotherapeutic management of paediatric heart failure and ACE-I use patterns: A European survey

Cristina Castro Díez, Feras Khalil, Holger Schwender, Michiel Dalinghaus, Ida Jovanovic, Nina Makowski, Christoph Male, Milica Bajcetic, Marijke Van Der Meulen, Saskia N. De Wildt, László Ablonczy, András Szatmári, Ingrid Klingmann, Jennifer Walsh, Stephanie Läer

Research output: Review article

1 Citation (Scopus)


Objective To characterise heart failure (HF) maintenance pharmacotherapy for children across Europe and investigate how angiotensin-converting enzyme inhibitors (ACE-I) are used in this setting. Methods A Europe-wide web-based survey was conducted between January and May 2015 among European paediatricians dedicated to cardiology. Results Out of 200-eligible, 100 physicians representing 100 hospitals in 27 European countries participated. All participants reported prescribing ACE-I to treat dilated cardiomyopathy-related HF and 97% in the context of congenital heart defects; 87% for single ventricle physiology. Twenty-six per cent avoid ACE-I in newborns. Captopril was most frequently selected as first-choice for newborns (73%) and infants and toddlers (66%) and enalapril for children (56%) and adolescents (58%). Reported starting and maintenance doses varied widely. Up to 72% of participants follow formal creatinine increase limits for decision-making when up-titrating; however, heterogeneity in the cut-off points selected existed. ACE-I formulations prescribed by 47% of participants are obtained from more than a single source. Regarding symptomatic HF maintenance therapy, 25 different initial drug combinations were reported, although 79% select a regimen that includes ACE-I and diuretic (thiazide and/or loop), 61% ACE-I and aldosterone antagonist; 44% start with beta-blocker, 52% use beta-blockers as an add-on drug. Of the 89 participants that prescribe pharmacotherapy to asymptomatic patients, 40% do not use ACE-I monotherapy or ACE-I-beta-blocker two-drug only combination. Conclusions Despite some reluctance to use them in newborns, ACE-I seem key in paediatric HF treatment strategies. Use in single ventricle patients seems frequent, in apparent contradiction with current paediatric evidence. Disparate dosage criteria and potential formulation-induced variability suggest significant differences may exist in the risk-benefit profile children are exposed to. No uniformity seems to exist in the drug regimens in use. The information collected provides relevant insight into real-life clinical practice and may facilitate research to identify the best therapeutic options for HF children.

Original languageEnglish
Article numbere000365
JournalBMJ Paediatrics Open
Issue number1
Publication statusPublished - jan. 1 2019

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Díez, C. C., Khalil, F., Schwender, H., Dalinghaus, M., Jovanovic, I., Makowski, N., Male, C., Bajcetic, M., Van Der Meulen, M., De Wildt, S. N., Ablonczy, L., Szatmári, A., Klingmann, I., Walsh, J., & Läer, S. (2019). Pharmacotherapeutic management of paediatric heart failure and ACE-I use patterns: A European survey. BMJ Paediatrics Open, 3(1), [e000365].