Digoxin utilization following the Norwood procedure in patients with hypoplastic left heart syndrome: A multicenter database analysis

Abstract

The use of Digoxin has been associated with improved interstage survival following stage 1 palliation of single ventricle heart disease. The objective of our study is to report changes in Digoxin use over time and variation across centers among neonates with hypoplastic left heart syndrome who have undergone stage 1 palliation. This retrospective study utilized data from the Pediatric Health Information System administrative database. All neonates with a diagnosis of hypoplastic left heart syndrome who underwent stage 1 palliation from 1/1/2010–12/31/2019 and survived to hospital discharge were included. Digoxin use during the interstage period was assessed using billing data on the day of or the day preceding discharge. Factors associated with Digoxin use include African American race, extracorporeal membrane oxygenation use during the stage 1 hospitalization, arrhythmias, and a higher median household income. Digoxin use increased significantly over time (19.3% 2010–2015 vs. 53% 2015–2019, p < 0.001). A high degree in variability was found in the use of Digoxin across centers (range 0% - 87.9% of discharges). 20 centers (55.6%) significantly increased their use of Digoxin after 2015, with higher volume centers increasing use more than lower volume centers. Digoxin use for infants with hypoplastic left heart syndrome in the interstage period has increased in the current era, with large variability across centers. Further investigation is warranted to reassess interstage mortality in the current era and validate the impact of Digoxin in an independent cohort.