Pediatric heart failure: A focus on low-income countries

Table 2 Medications used for pediatric heart failure

Drug/group	Evidence for pediatric HF	Recommendation
Renin-angiotensin-aldosterone system	PANORAMA study[50] did not show advantage of sacubitril/valsartan over ACEI	Angiotensin converting enzyme inhibitors are used routinely
Inhibitors: Captopril, enalapril, lisinopril and sacubitril/valsartan	A study involving 23 patients showed improvement of EF and LV dimensions with a low dose[51]	The United States Food and Drug Administration has approved sacubitril/valsartan pediatric HF > 1 year of age
β-blockers	There is not enough evidence to support or discourage the use[52]	May be used with close observation
Carvedilol
Mineralocorticoid receptor antagonists (spironolactone)	Evidence mainly derived from adult studies[53]	Used in HF
Digoxin	Evidence mainly derived from adult studies	Used as 3rd or 4th line in CHF
		Used in tachyarrhythmias
Diuretics	Evidence mainly derived from adult studies[54]	Loop diuretics are used for fluid overload
Furosemide		Addition of other diuretics enhances loop diuretic effect
Spironolactone
Thiazides
Metolazone
Sodium-glucose cotransporter-2 inhibitors	Use in children was found to be safe and well tolerated in a meta-analysis[55]	Awaiting more studies to be approved
Ivabradine	Evidence of improvement in HF[56]	Can be used in children

HF: Heart failure; ACEI: Angiotensin converting enzyme inhibitors; EF: Ejection fraction; LV: Left ventricle; CHF: Congestive heart failure.