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- W2341822171 abstract "β-blocker medications have a favorable safety profile in adult heart failure patients. However, there are no long-term studies on utilization or safety of β-blockers in pediatric heart failure. Therefore, we aimed to describe dose ranges, adverse events, and changes in cardiac function in a well characterized population of children with dilated cardiomyopathy (DCM) treated with carvedilol. The Pediatric Cardiomyopathy Registry was used to identify patients who were treated with carvedilol from 1997 to 2005. The decision to treat was made by the local physician. The cohort included 118 patients (52% female, 58% white), median age at start of treatment was 4.4 years (interquartile range [IQR] 1.0-13.3) and median weight 18.2 kg (IQR 8.7-52.0). Most cases were idiopathic, (66%) with myocarditis (15%) and familial DCM (12%) as the most common identifiable causes. The majority (63%) had symptoms of heart with 95% on angiotensin converting enzyme inhibitor at carvedilol initiation. The median carvedilol dose at initiation was 0.16 mg/kg/day (IQR: 0.1-0.3) and the median maximal dose achieved was 0.5 mg/kg/day (IQR: 0.2-0.8). The median duration of carvedilol use was 361 days (IQR: 101-958) with 18% treated for > 3 years. Blood pressure was within normal limits for the majority of patients at all time points evaluated (>95% for systolic and >75% for diastolic). There were no episodes of 3rd degree heart block. Carvedilol was discontinued in 41 patients, mostly secondary to heart transplantation (61%) or resolution of cardiac disease (12%). There were 2 hospitalizations for bronchial reactivity and none for hypotension or bradycardia. Four patients stopped carvedilol secondary to an apparent side-effect. The shortening fraction increased from 16% ± 8 (median 16%, IQR: 10-22%) at carvedilol initiation (n=98) to 21% ± 9 (median 21%, IQR: 15-25%) at 1 year (n=49) (p=0.001), 23% ± 9 (median 22%, IQR: 16-28%) at 2 years (n=20) (p=0.04), and 22% ± 8 (median 22%, IQR: 16-30%) at 3 years (n=18) post-carvedilol initiation (p=0.04). Carvedilol was well tolerated in the majority of patients with up to 3 years of medication administration with evidence of reverse remodeling in survivors. Further study of the long term remodeling effects of β-blockers in pediatric heart failure is required." @default.
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- W2341822171 date "2016-04-01" @default.
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- W2341822171 title "Utilization and Safety of Long-Term Carvedilol in Pediatric Dilated Cardiomyopathy: A Multicenter Study from the Pediatric Cardiomyopathy Registry" @default.
- W2341822171 doi "https://doi.org/10.1016/j.healun.2016.01.441" @default.
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