Between 20, phase I of the NPC‐QIC assembled the largest ever cohort of infants with HLHS. Because of the high risk of interstage mortality, founders of the NPC‐QIC were driven to change the prognosis of HLHS by engaging all stakeholders in innovation through local observation and data sharing. 1, 2 Patterned on the Institute of Medicine's Learning Healthcare System framework, the NPC‐QIC (National Pediatric Cardiology Quality Improvement Collaborative) was designed as a community for collaborative innovation. Mortality during the interstage-the period between discharge following S1P and admission for S2P-was common, previously occurring in 10% to 15% of infants with HLHS. #Qic file converter series#Most infants with HLHS undergo a series of 3 palliative cardiac surgeries: stage I Norwood procedure (S1P) within a few days of birth, stage II superior cavopulmonary anastomosis procedure (S2P) at 4 to 6 months, and stage III (Fontan) procedure at 2 to 4 years. It is also rare, affecting an estimated 1 in every 4344 live‐born infants annually in the United States. Hypoplastic left heart syndrome (HLHS) is a complex and high‐risk heart defect that requires intensive early intervention. In multivariable analysis of patients with complete echocardiographic data (n=812), ACEI prescription was more common with at least moderate atrioventricular valve regurgitation (OR, 1.88 95% CI, 1.22–2.31). In multivariable analysis of all patients, atrioventricular septal defect (odds ratio, 1.84 95% CI, 1.28–2.65) or double outlet right ventricle (OR, 1.47 CI, 1.02–2.11), and preoperative mechanical ventilation (OR, 1.37 95% CI, 1.12–1.68) were associated with increased ACEI prescription. There was no difference in interstage mortality ( P=0.662), change in atrioventricular valve regurgitation ( P=0.101), or change in ventricular dysfunction ( P=0.134) between groups. ACEI prescription declined from 2011 to 2016 compared with pre‐2010 (36.8% versus 45% P=0.005) with significant variation across centers (range 7–100% P<0.001) and decreased prescribing rates associated with increased center volume ( P=0.004). ACEI were prescribed at stage I Norwood procedure discharge in 38% of patients. Analysis of all patients (n=2180) enrolled in NPC‐QIC from 2008 to 2016 included preoperative anatomy, risk factors, and echocardiographic data.
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