PP-3 Standard of care for children with heart failure in europe: results of a survey and a subsequent delphi questionnaire

Abstract

Background Paediatric heart failure (HF) has an import-ant economic and social impact in public health. Drugs acting on the renin-angiotensin system are regarded as mainstay to lower the burden of HF for patients and families. A safe and efficient use especially in young chil-dren has been debated since several years and remains a challenge for physicians. We aimed to characterise the different therapeutic strategies for the management of paediatric HF that are currently practiced across Europe with special focus on the use of Angiotensin Converting Enzyme Inhibitors (ACE-I). Methods A Europe-wide web-based survey and a sub-sequent DELPHI questionnaire was developed in the con-text of EU’s Seventh Framework Programme under grant agreement n°6 02 295 using standard recommendations for survey design. The questionnaire consisted of 23 ques-tions addressing different aspects of drug therapy for HF in children. Use patterns of ACE-I i.e. dosage by age group, effectiveness and toxicity assessment according to HF ae-tiology where investigated. Clinicians from 204 different hospitals of 39 European countries were invited via e-mail to participate. The subsequent DELPHI process discussed controversial responses within a selected expert panel in two rounds. Results The response rate of the survey had been 50%. The survey delivered valuable information about the current paediatric heart failure therapy, especially with regard to the pattern of ACE-I use. Enalapril seems to be already the ACE-inhibitor of choice for children and ad-olescents. A suitable formulation and knowledge about dosing as well as adverse events might offer Enalapril also for neonates and infants. Several controversial aspects which were identified within the survey and which are re-lated to paediatric heart failure therapy had been put up for discussion to the DELPHI expert panel. They showed a high degree of consensus in their professional criteria about most of the contents presented for discussion. Pos-sible starting points in the way towards a standardisation of paediatric heart failure therapy were identified. With re-gard to non-consensus statements, DELPHI experts pro-vided a better visibility to some aspects of clinical practice with greater disparity of opinio Diagnostic and therapeu-tic approachesns among physicians. Conclusion This survey and the subsequent DELPHI questionnaire provided an overview of the clinical treat-ment routine of paediatric HF across Europe. ACE-I seem to be a crucial part of the treatment strategies. Consensus but also still controversial aspects of clinical practice rou-tines for a safe and effective use of heart failure treatment for children in Europe were identified. The research leading to these results has received funding from the EU’s Seventh Framework Programme (FP7/2007-2013) under grant agreement n°6 02 295 (LENA).