Variation in the use of pulmonary vasodilators in children and adolescents with pulmonary hypertension: a study using data from the MarketScan® insurance claims database
Despite progress in pharmacotherapy in pediatric pulmonary hypertension, real-world patterns of directed pulmonary hypertension therapy have not been studied in the current era. A retrospective observational study of children (≤18 years) with pulmonary hypertension was performed using data from the...
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| Published in | Pulmonary circulation Vol. 10; no. 3; pp. 1 - 9 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
London, England
SAGE Publications
01.07.2020
John Wiley & Sons, Inc Wiley |
| Subjects | |
| Online Access | Get full text |
| ISSN | 2045-8940 2045-8932 2045-8940 |
| DOI | 10.1177/2045894020933083 |
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| Abstract | Despite progress in pharmacotherapy in pediatric pulmonary hypertension, real-world patterns of directed pulmonary hypertension therapy have not been studied in the current era. A retrospective observational study of children (≤18 years) with pulmonary hypertension was performed using data from the MarketScan® Commercial and Medicaid claims databases. Associations between etiology of pulmonary hypertension and pharmaceutical regimen were evaluated, as were the associations between subject social and geographic characteristics (insurance-type, race, and/or census region) and regimen. Annualized costs of single- and multi-class regimens were calculated. In total, 873 subjects were studied, of which 94% received phosphodiesterase-5 inhibitors, 31% endothelin receptor antagonist, 9% prostacyclin analogs, and 7% calcium channel blockers. Monotherapy was used in 72% of subjects. Phosphodiesterase-5 inhibitors monotherapy was the most common regimen (93%). Subjects with idiopathic pulmonary hypertension, congenital heart disease, and unclassified pulmonary hypertension receive more than one agent and were more likely to receive both endothelin receptor antagonist and prostacyclin analogs than other forms of pulmonary hypertension. Compared to recipients of public insurance, subjects with commercial insurance were more likely to receive more intense therapy (p = 0.003), which was confirmed in multivariable analysis (OR: 1.4, p = 0.03). Receipt of commercial insurance was also associated with increased annual costs across all subjects (p < 0.001) and for the most common specific regimens. The majority of children with pulmonary hypertension receive phosphodiesterase monotherapy, followed by phosphodiesterase–endothelin receptor antagonist two drug regimens, and finally the addition of prostacyclin analogs for three-drug therapy. However, even after adjustment for measurable confounders, commercial insurance was associated with higher intensity care and higher costs (even within specific classes of pulmonary vasodilators). The effect of these associations on clinical outcome cannot be discerned from the current data set, but patterns of treatment deserve further attention. |
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| AbstractList | Despite progress in pharmacotherapy in pediatric pulmonary hypertension, real‐world patterns of directed pulmonary hypertension therapy have not been studied in the current era. A retrospective observational study of children (≤18 years) with pulmonary hypertension was performed using data from the MarketScan® Commercial and Medicaid claims databases. Associations between etiology of pulmonary hypertension and pharmaceutical regimen were evaluated, as were the associations between subject social and geographic characteristics (insurance‐type, race, and/or census region) and regimen. Annualized costs of single‐ and multi‐class regimens were calculated. In total, 873 subjects were studied, of which 94% received phosphodiesterase‐5 inhibitors, 31% endothelin receptor antagonist, 9% prostacyclin analogs, and 7% calcium channel blockers. Monotherapy was used in 72% of subjects. Phosphodiesterase‐5 inhibitors monotherapy was the most common regimen (93%). Subjects with idiopathic pulmonary hypertension, congenital heart disease, and unclassified pulmonary hypertension receive more than one agent and were more likely to receive both endothelin receptor antagonist and prostacyclin analogs than other forms of pulmonary hypertension. Compared to recipients of public insurance, subjects with commercial insurance were more likely to receive more intense therapy (
p
= 0.003), which was confirmed in multivariable analysis (OR: 1.4,
p
= 0.03). Receipt of commercial insurance was also associated with increased annual costs across all subjects (
p
< 0.001) and for the most common specific regimens. The majority of children with pulmonary hypertension receive phosphodiesterase monotherapy, followed by phosphodiesterase–endothelin receptor antagonist two drug regimens, and finally the addition of prostacyclin analogs for three‐drug therapy. However, even after adjustment for measurable confounders, commercial insurance was associated with higher intensity care and higher costs (even within specific classes of pulmonary vasodilators). The effect of these associations on clinical outcome cannot be discerned from the current data set, but patterns of treatment deserve further attention. Despite progress in pharmacotherapy in pediatric pulmonary hypertension, real-world patterns of directed pulmonary hypertension therapy have not been studied in the current era. A retrospective observational study of children (≤18 years) with pulmonary hypertension was performed using data from the MarketScan® Commercial and Medicaid claims databases. Associations between etiology of pulmonary hypertension and pharmaceutical regimen were evaluated, as were the associations between subject social and geographic characteristics (insurance-type, race, and/or census region) and regimen. Annualized costs of single- and multi-class regimens were calculated. In total, 873 subjects were studied, of which 94% received phosphodiesterase-5 inhibitors, 31% endothelin receptor antagonist, 9% prostacyclin analogs, and 7% calcium channel blockers. Monotherapy was used in 72% of subjects. Phosphodiesterase-5 inhibitors monotherapy was the most common regimen (93%). Subjects with idiopathic pulmonary hypertension, congenital heart disease, and unclassified pulmonary hypertension receive more than one agent and were more likely to receive both endothelin receptor antagonist and prostacyclin analogs than other forms of pulmonary hypertension. Compared to recipients of public insurance, subjects with commercial insurance were more likely to receive more intense therapy ( = 0.003), which was confirmed in multivariable analysis (OR: 1.4, = 0.03). Receipt of commercial insurance was also associated with increased annual costs across all subjects ( < 0.001) and for the most common specific regimens. The majority of children with pulmonary hypertension receive phosphodiesterase monotherapy, followed by phosphodiesterase-endothelin receptor antagonist two drug regimens, and finally the addition of prostacyclin analogs for three-drug therapy. However, even after adjustment for measurable confounders, commercial insurance was associated with higher intensity care and higher costs (even within specific classes of pulmonary vasodilators). The effect of these associations on clinical outcome cannot be discerned from the current data set, but patterns of treatment deserve further attention. Despite progress in pharmacotherapy in pediatric pulmonary hypertension, real‐world patterns of directed pulmonary hypertension therapy have not been studied in the current era. A retrospective observational study of children (≤18 years) with pulmonary hypertension was performed using data from the MarketScan® Commercial and Medicaid claims databases. Associations between etiology of pulmonary hypertension and pharmaceutical regimen were evaluated, as were the associations between subject social and geographic characteristics (insurance‐type, race, and/or census region) and regimen. Annualized costs of single‐ and multi‐class regimens were calculated. In total, 873 subjects were studied, of which 94% received phosphodiesterase‐5 inhibitors, 31% endothelin receptor antagonist, 9% prostacyclin analogs, and 7% calcium channel blockers. Monotherapy was used in 72% of subjects. Phosphodiesterase‐5 inhibitors monotherapy was the most common regimen (93%). Subjects with idiopathic pulmonary hypertension, congenital heart disease, and unclassified pulmonary hypertension receive more than one agent and were more likely to receive both endothelin receptor antagonist and prostacyclin analogs than other forms of pulmonary hypertension. Compared to recipients of public insurance, subjects with commercial insurance were more likely to receive more intense therapy (p = 0.003), which was confirmed in multivariable analysis (OR: 1.4, p = 0.03). Receipt of commercial insurance was also associated with increased annual costs across all subjects (p < 0.001) and for the most common specific regimens. The majority of children with pulmonary hypertension receive phosphodiesterase monotherapy, followed by phosphodiesterase–endothelin receptor antagonist two drug regimens, and finally the addition of prostacyclin analogs for three‐drug therapy. However, even after adjustment for measurable confounders, commercial insurance was associated with higher intensity care and higher costs (even within specific classes of pulmonary vasodilators). The effect of these associations on clinical outcome cannot be discerned from the current data set, but patterns of treatment deserve further attention. Despite progress in pharmacotherapy in pediatric pulmonary hypertension, real-world patterns of directed pulmonary hypertension therapy have not been studied in the current era. A retrospective observational study of children (≤18 years) with pulmonary hypertension was performed using data from the MarketScan® Commercial and Medicaid claims databases. Associations between etiology of pulmonary hypertension and pharmaceutical regimen were evaluated, as were the associations between subject social and geographic characteristics (insurance-type, race, and/or census region) and regimen. Annualized costs of single- and multi-class regimens were calculated. In total, 873 subjects were studied, of which 94% received phosphodiesterase-5 inhibitors, 31% endothelin receptor antagonist, 9% prostacyclin analogs, and 7% calcium channel blockers. Monotherapy was used in 72% of subjects. Phosphodiesterase-5 inhibitors monotherapy was the most common regimen (93%). Subjects with idiopathic pulmonary hypertension, congenital heart disease, and unclassified pulmonary hypertension receive more than one agent and were more likely to receive both endothelin receptor antagonist and prostacyclin analogs than other forms of pulmonary hypertension. Compared to recipients of public insurance, subjects with commercial insurance were more likely to receive more intense therapy (p = 0.003), which was confirmed in multivariable analysis (OR: 1.4, p = 0.03). Receipt of commercial insurance was also associated with increased annual costs across all subjects (p < 0.001) and for the most common specific regimens. The majority of children with pulmonary hypertension receive phosphodiesterase monotherapy, followed by phosphodiesterase–endothelin receptor antagonist two drug regimens, and finally the addition of prostacyclin analogs for three-drug therapy. However, even after adjustment for measurable confounders, commercial insurance was associated with higher intensity care and higher costs (even within specific classes of pulmonary vasodilators). The effect of these associations on clinical outcome cannot be discerned from the current data set, but patterns of treatment deserve further attention. Despite progress in pharmacotherapy in pediatric pulmonary hypertension, real-world patterns of directed pulmonary hypertension therapy have not been studied in the current era. A retrospective observational study of children (≤18 years) with pulmonary hypertension was performed using data from the MarketScan® Commercial and Medicaid claims databases. Associations between etiology of pulmonary hypertension and pharmaceutical regimen were evaluated, as were the associations between subject social and geographic characteristics (insurance-type, race, and/or census region) and regimen. Annualized costs of single- and multi-class regimens were calculated. In total, 873 subjects were studied, of which 94% received phosphodiesterase-5 inhibitors, 31% endothelin receptor antagonist, 9% prostacyclin analogs, and 7% calcium channel blockers. Monotherapy was used in 72% of subjects. Phosphodiesterase-5 inhibitors monotherapy was the most common regimen (93%). Subjects with idiopathic pulmonary hypertension, congenital heart disease, and unclassified pulmonary hypertension receive more than one agent and were more likely to receive both endothelin receptor antagonist and prostacyclin analogs than other forms of pulmonary hypertension. Compared to recipients of public insurance, subjects with commercial insurance were more likely to receive more intense therapy (p = 0.003), which was confirmed in multivariable analysis (OR: 1.4, p = 0.03). Receipt of commercial insurance was also associated with increased annual costs across all subjects (p < 0.001) and for the most common specific regimens. The majority of children with pulmonary hypertension receive phosphodiesterase monotherapy, followed by phosphodiesterase-endothelin receptor antagonist two drug regimens, and finally the addition of prostacyclin analogs for three-drug therapy. However, even after adjustment for measurable confounders, commercial insurance was associated with higher intensity care and higher costs (even within specific classes of pulmonary vasodilators). The effect of these associations on clinical outcome cannot be discerned from the current data set, but patterns of treatment deserve further attention.Despite progress in pharmacotherapy in pediatric pulmonary hypertension, real-world patterns of directed pulmonary hypertension therapy have not been studied in the current era. A retrospective observational study of children (≤18 years) with pulmonary hypertension was performed using data from the MarketScan® Commercial and Medicaid claims databases. Associations between etiology of pulmonary hypertension and pharmaceutical regimen were evaluated, as were the associations between subject social and geographic characteristics (insurance-type, race, and/or census region) and regimen. Annualized costs of single- and multi-class regimens were calculated. In total, 873 subjects were studied, of which 94% received phosphodiesterase-5 inhibitors, 31% endothelin receptor antagonist, 9% prostacyclin analogs, and 7% calcium channel blockers. Monotherapy was used in 72% of subjects. Phosphodiesterase-5 inhibitors monotherapy was the most common regimen (93%). Subjects with idiopathic pulmonary hypertension, congenital heart disease, and unclassified pulmonary hypertension receive more than one agent and were more likely to receive both endothelin receptor antagonist and prostacyclin analogs than other forms of pulmonary hypertension. Compared to recipients of public insurance, subjects with commercial insurance were more likely to receive more intense therapy (p = 0.003), which was confirmed in multivariable analysis (OR: 1.4, p = 0.03). Receipt of commercial insurance was also associated with increased annual costs across all subjects (p < 0.001) and for the most common specific regimens. The majority of children with pulmonary hypertension receive phosphodiesterase monotherapy, followed by phosphodiesterase-endothelin receptor antagonist two drug regimens, and finally the addition of prostacyclin analogs for three-drug therapy. However, even after adjustment for measurable confounders, commercial insurance was associated with higher intensity care and higher costs (even within specific classes of pulmonary vasodilators). The effect of these associations on clinical outcome cannot be discerned from the current data set, but patterns of treatment deserve further attention. Despite progress in pharmacotherapy in pediatric pulmonary hypertension, real-world patterns of directed pulmonary hypertension therapy have not been studied in the current era. A retrospective observational study of children (≤18 years) with pulmonary hypertension was performed using data from the MarketScan® Commercial and Medicaid claims databases. Associations between etiology of pulmonary hypertension and pharmaceutical regimen were evaluated, as were the associations between subject social and geographic characteristics (insurance-type, race, and/or census region) and regimen. Annualized costs of single- and multi-class regimens were calculated. In total, 873 subjects were studied, of which 94% received phosphodiesterase-5 inhibitors, 31% endothelin receptor antagonist, 9% prostacyclin analogs, and 7% calcium channel blockers. Monotherapy was used in 72% of subjects. Phosphodiesterase-5 inhibitors monotherapy was the most common regimen (93%). Subjects with idiopathic pulmonary hypertension, congenital heart disease, and unclassified pulmonary hypertension receive more than one agent and were more likely to receive both endothelin receptor antagonist and prostacyclin analogs than other forms of pulmonary hypertension. Compared to recipients of public insurance, subjects with commercial insurance were more likely to receive more intense therapy ( p = 0.003), which was confirmed in multivariable analysis (OR: 1.4, p = 0.03). Receipt of commercial insurance was also associated with increased annual costs across all subjects ( p < 0.001) and for the most common specific regimens. The majority of children with pulmonary hypertension receive phosphodiesterase monotherapy, followed by phosphodiesterase–endothelin receptor antagonist two drug regimens, and finally the addition of prostacyclin analogs for three-drug therapy. However, even after adjustment for measurable confounders, commercial insurance was associated with higher intensity care and higher costs (even within specific classes of pulmonary vasodilators). The effect of these associations on clinical outcome cannot be discerned from the current data set, but patterns of treatment deserve further attention. |
| Author | Giglia, Therese M. O'Byrne, Michael L. Frank, David B. Davidson, Alex Katcoff, Hannah Avitabile, Catherine M. Faerber, Jennifer A. |
| AuthorAffiliation | 4 Leonard Davis Institute and Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia, PA, USA 2 Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA 1 Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA 3 Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA |
| AuthorAffiliation_xml | – name: 3 Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA – name: 1 Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA – name: 2 Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA – name: 4 Leonard Davis Institute and Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia, PA, USA |
| Author_xml | – sequence: 1 givenname: Michael L. orcidid: 0000-0001-6023-1634 surname: O'Byrne fullname: O'Byrne, Michael L. – sequence: 2 givenname: Jennifer A. surname: Faerber fullname: Faerber, Jennifer A. – sequence: 3 givenname: Hannah surname: Katcoff fullname: Katcoff, Hannah – sequence: 4 givenname: David B. surname: Frank fullname: Frank, David B. – sequence: 5 givenname: Alex surname: Davidson fullname: Davidson, Alex – sequence: 6 givenname: Therese M. surname: Giglia fullname: Giglia, Therese M. – sequence: 7 givenname: Catherine M. surname: Avitabile fullname: Avitabile, Catherine M. |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/35154663$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1161_JAHA_121_024197 crossref_primary_10_1002_ccd_30506 crossref_primary_10_1161_JAHA_121_024112 crossref_primary_10_1016_j_ahj_2021_09_012 |
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| Publisher | SAGE Publications John Wiley & Sons, Inc Wiley |
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| References | Galiè, Barberà, Frost 2015; 373 O'Byrne, Glatz, Shinohara 2015; 169 Fraisse, Jais, Schleich 2010; 103 O'Byrne, Gillespie, Shinohara 2016; 117 Jayaram, Spertus, O'Byrne 2017; 183 O'Byrne, Shinohara, Grant 2017; 192 O'Byrne, Glatz, Song 2018; 138 O'Byrne, Millenson, Grady 2019; 217 O'Byrne, Kennedy, Kanter 2018; 7 Marín, Rotés, Ogando 2014; 190 Humpl, Berger, Austin 2017; 27 Montalbano, Rodean, Kangas 2016; 137 Hansmann, Apitz 2016; 102 Thornhill, Gibson, Cutler 2018; 72 Jimenez, Quistberg, Vavilala 2017; 139 Beghetti, Berger, Schulze-Neick 2013; 42 Van Loon, Roofthooft, Delhaas 2010; 106 Douwes, Humpl, Bonnet 2016; 67 Li, Jick, Breitenstein 2017; 7 Barst, McGoon, Elliott 2012; 125 Abman, Hansmann, Archer 2015; 132 O'Byrne, Glatz, Hanna 2015; 66 Beghetti, Schulze-Neick, Berger 2016; 203 Moledina, Hislop, Foster 2010; 96 O'Byrne, Glatz, Faerber 2019; 8 Zijlstra, Douwes, Rosenzweig 2014; 63 Link, Glazer, Torres 2011; 139 Graves, Rivara, Vavilala 2015; 105 Agarwal, Thombley, Broberg 2019; 8 Goss, Everett, Mourani 2017; 7 Sitbon, Sattler, Bertoletti 2016; 47 Leshem, Moritz, Curns 2014; 134 Lauffenburger, Balasubramanian, Farley 2013; 22 Van Loon, Roofthooft, Hillege 2011; 124 Berger, Beghetti, Humpl 2012; 379 Douwes, Roofthooft, Van Loon 2014; 100 Mullen, Andrus, Labella 2014; 145 Hill, Lim, Everett 2010; 76 2019; 8 2010; 76 2017; 7 2011; 139 2013; 22 2015; 105 2010; 106 2017; 27 2015; 169 2010; 103 2013; 42 2016; 102 2014; 190 2017; 192 2016; 203 2012; 125 2014; 63 2014; 134 2017; 139 2018; 7 2011; 124 2018; 138 2015; 66 2015; 373 2015; 132 2017; 183 2016; 117 2018; 72 2016; 137 2019; 217 2014; 100 2012; 379 2010; 96 2016; 47 2014; 145 2016; 67 e_1_2_10_23_1 e_1_2_10_24_1 e_1_2_10_45_1 e_1_2_10_21_1 e_1_2_10_44_1 e_1_2_10_22_1 e_1_2_10_43_1 e_1_2_10_42_1 e_1_2_10_20_1 e_1_2_10_41_1 e_1_2_10_40_1 e_1_2_10_2_1 e_1_2_10_4_1 e_1_2_10_18_1 e_1_2_10_3_1 e_1_2_10_19_1 e_1_2_10_6_1 e_1_2_10_16_1 e_1_2_10_39_1 e_1_2_10_5_1 e_1_2_10_17_1 e_1_2_10_38_1 e_1_2_10_8_1 e_1_2_10_14_1 e_1_2_10_37_1 e_1_2_10_7_1 e_1_2_10_15_1 e_1_2_10_36_1 e_1_2_10_12_1 e_1_2_10_35_1 e_1_2_10_9_1 e_1_2_10_13_1 e_1_2_10_34_1 e_1_2_10_10_1 e_1_2_10_33_1 e_1_2_10_11_1 e_1_2_10_32_1 e_1_2_10_31_1 e_1_2_10_30_1 e_1_2_10_29_1 e_1_2_10_27_1 e_1_2_10_28_1 e_1_2_10_25_1 e_1_2_10_26_1 |
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pulmonary arterial hypertension mortality and hospitalizations implications for database studies publication-title: Chest – volume: 67 start-page: 1312 year: 2016 end-page: 1323 article-title: Acute vasodilator response in pediatric pulmonary arterial hypertension: current clinical practice from the TOPP registry publication-title: J Am Coll Cardiol – volume: 76 start-page: 865 year: 2010 end-page: 873 article-title: Assessment of pulmonary hypertension in the pediatric catheterization laboratory: current insights from the magic registry publication-title: Cathet Cardiovasc Intervent – volume: 125 start-page: 113 year: 2012 end-page: 122 article-title: Survival in childhood pulmonary arterial hypertension: insights from the registry to evaluate early and long‐term pulmonary arterial hypertension disease management publication-title: Circulation – volume: 72 start-page: 2443 year: 2018 end-page: 2454 article-title: Antibiotic prophylaxis and incidence of endocarditis before and after the 2007 AHA recommendations publication-title: J Am Coll Cardiol – volume: 8 year: 2019 article-title: Interhospital variation in the costs of pediatric/congenital cardiac catheterization laboratory procedures: analysis of data from the Pediatric Health Information Systems Database publication-title: J Amer Heart Assoc – volume: 190 start-page: 1421 year: 2014 end-page: 1429 article-title: Assessing pulmonary hypertensive vascular disease in childhood. 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Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK publication-title: Heart – volume: 169 start-page: 823.e5 year: 2015 end-page: 832.e5 article-title: Effect of center catheterization volume on risk of catastrophic adverse event after cardiac catheterization in children publication-title: Am Heart J – volume: 124 start-page: 1755 year: 2011 end-page: 1764 article-title: Pediatric pulmonary hypertension in the Netherlands: epidemiology and characterization during the period 1991 to 2005 publication-title: Circulation – volume: 132 start-page: 2037 year: 2015 end-page: 2099 article-title: Pediatric pulmonary hypertension: guidelines from the American Heart Association and American Thoracic Society publication-title: Circulation – volume: 106 start-page: 117 year: 2010 end-page: 124 article-title: Outcome of pediatric patients with pulmonary arterial hypertension in the era of new medical therapies publication-title: Am J Cardiol – volume: 217 start-page: 121 year: 2019 end-page: 130 article-title: Trends in transcatheter and operative closure of patent ductus arteriosus in neonatal intensive care units publication-title: Am Heart J – volume: 105 start-page: e35 year: 2015 end-page: e41 article-title: Health care costs 1 year after pediatric traumatic brain injury publication-title: Am J Public Health – volume: 138 start-page: 2119 year: 2018 end-page: 2129 article-title: Association between variation in Preoperative Care Before Arterial Switch Operation and Outcomes in Patients With Transposition of the Great Arteries publication-title: Circulation – volume: 42 start-page: 689 year: 2013 end-page: 700 article-title: Diagnostic evaluation of paediatric pulmonary hypertension in current clinical practice publication-title: Eur Respir J – volume: 27 start-page: 1123 year: 2017 end-page: 1132 article-title: Treatment initiation in paediatric pulmonary hypertension: insights from a multinational registry publication-title: Cardiol Young – volume: 117 start-page: 121 year: 2016 end-page: 126 article-title: Cost comparison of transcatheter and operative pulmonary valve replacement (from the Pediatric Health Information Systems Database) publication-title: Am J Cardiol – volume: 63 start-page: 2159 year: 2014 end-page: 2169 article-title: Survival differences in pediatric pulmonary arterial hypertension: clues to a better understanding of outcome and optimal treatment strategies publication-title: J Am Coll Cardiol – volume: 379 start-page: 537 year: 2012 end-page: 546 article-title: Clinical features of paediatric pulmonary hypertension: a registry study publication-title: Lancet – volume: 8 year: 2019 article-title: Age‐ and lesion‐related comorbidity burden among US adults with congenital heart disease: a population‐based study publication-title: J Amer Heart Assoc – ident: e_1_2_10_15_1 doi: 10.1136/heartjnl-2015-309103 – ident: e_1_2_10_42_1 doi: 10.1164/rccm.201406-1052OC – ident: e_1_2_10_28_1 doi: 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10.1016/j.amjcard.2015.10.011 – ident: e_1_2_10_5_1 doi: 10.1161/CIRCULATIONAHA.110.969584 – ident: e_1_2_10_10_1 doi: 10.1016/j.amjcard.2010.02.023 – ident: e_1_2_10_3_1 doi: 10.1161/CIRCULATIONAHA.111.026591 |
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| Snippet | Despite progress in pharmacotherapy in pediatric pulmonary hypertension, real-world patterns of directed pulmonary hypertension therapy have not been studied... Despite progress in pharmacotherapy in pediatric pulmonary hypertension, real‐world patterns of directed pulmonary hypertension therapy have not been studied... Despite progress in pharmacotherapy in pediatric pulmonary hypertension, real-world patterns of directed pulmonary hypertension therapy have not been studied... |
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| SourceType | Open Website Open Access Repository Aggregation Database Index Database Enrichment Source Publisher |
| StartPage | 1 |
| SubjectTerms | Cardiology Childrens health Drug therapy outcomes research pediatric cardiology Pulmonary hypertension |
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| Title | Variation in the use of pulmonary vasodilators in children and adolescents with pulmonary hypertension: a study using data from the MarketScan® insurance claims database |
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