Clinical Practice Variation of Statin Use in Pediatric Heart Transplantation

Abstract

<h3>Purpose</h3> Universal initiation of statin therapy within 2 weeks of heart transplantation (HT) is a Class 1A recommendation in adults due to improved morbidity and mortality via reduction of coronary graft vasculopathy. Data regarding the benefit of statins in pediatric transplant patients is equivocal, although the safety and efficacy of statins in children with conditions including familial hyperlipidemias has now been well established. Previous work reported only 1/3 of pediatric transplant patients were prescribed a statin in the period before 2012. We sought to establish statin prescribing practices in a sample of U.S. pediatric HT recipients in the current era, hypothesizing that use of statins in pediatrics increases with age and has increased over time. <h3>Methods</h3> We performed a retrospective study of a geographically representative sample of U.S. children using the MarketScan® Commercial and Medicaid claims databases. The study population was children who underwent HT between the ages of 2 and 19 and had ≥3 years of continuous coverage from 1/1/2013-6/30/2018. We assessed the average age for initiation of statins and the probability of statin prescription by age. <h3>Results</h3> Of the 8.4 million children with available Marketscan data, 876 children (age: 9.8 ± 5.0 years, 54% male) underwent a HT prior to or during the study period. A higher proportion of HT recipients received Medicaid than commercial insurance coverage (56% vs. 44%, p<0.001). 35% (95% CI 32-38%) of HT recipients were on a statin, at an average age of 11.47 ± 4.6 years at the time of the first statin prescription. The earliest age of statin initiation was at 2 years. Likelihood of statin prescription increased with age (18% of those between 2-5 years, 25% between 6-10 years, and 47% in those over 13 years). <h3>Conclusion</h3> Only 1/3 of pediatric HT patients filled a prescription for a statin in this recent cohort, similar to historical rates. Younger children were less likely to receive statins, which may be related to lack of liquid formulation or lack of historical safety data in young children. However, only half of teenagers receive statins by age 19 which is contrary to current adult HT guidelines. This suggests that statin prescribing practices in children after HT should be a focus for improving adherence to national guidelines. Future work will look at effects of socioeconomic factors in statin prescribing patterns.