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Pediatric cardiovascular safety: challenges in drug and device development and clinical application.

Publication ,  Journal Article
Bates, KE; Vetter, VL; Li, JS; Cummins, S; Aguel, F; Almond, C; Dubin, AM; Elia, J; Finkle, J; Hausner, EA; Joseph, F; Karkowsky, AM ...
Published in: Am Heart J
October 2012

Development of pediatric medications and devices is complicated by differences in pediatric physiology and pathophysiology (both compared with adults and within the pediatric age range), small patient populations, and practical and ethical challenges to designing clinical trials. This article summarizes the discussions that occurred at a Cardiac Safety Research Consortium-sponsored Think Tank convened on December 10, 2010, where members from academia, industry, and regulatory agencies discussed important issues regarding pediatric cardiovascular safety of medications and cardiovascular devices. Pediatric drug and device development may use adult data but often requires additional preclinical and clinical testing to characterize effects on cardiac function and development. Challenges in preclinical trials include identifying appropriate animal models, clinically relevant efficacy end points, and methods to monitor cardiovascular safety. Pediatric clinical trials have different ethical concerns from adult trials, including consideration of the subjects' families. Clinical trial design in pediatrics should assess risks and benefits as well as incorporate input from families. Postmarketing surveillance, mandated by federal law, plays an important role in both drug and device safety assessment and becomes crucial in the pediatric population because of the limitations of premarketing pediatric studies. Solutions for this wide array of issues will require collaboration between academia, industry, and government as well as creativity in pediatric study design. Formation of various epidemiologic tools including registries to describe outcomes of pediatric cardiac disease and its treatment as well as cardiac effects of noncardiovascular medications, should inform preclinical and clinical development and improve benefit-risk assessments for the patients. The discussions in this article summarize areas of emerging consensus and other areas in which consensus remains elusive and provide suggestions for additional research to further our knowledge and understanding of this topic.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

October 2012

Volume

164

Issue

4

Start / End Page

481 / 492

Location

United States

Related Subject Headings

  • Product Surveillance, Postmarketing
  • Patient Safety
  • Models, Animal
  • Humans
  • Government Regulation
  • Equipment Design
  • Electrocardiography
  • Drug Evaluation, Preclinical
  • Drug Design
  • Dose-Response Relationship, Drug
 

Citation

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Bates, K. E., Vetter, V. L., Li, J. S., Cummins, S., Aguel, F., Almond, C., … Krucoff, M. W. (2012). Pediatric cardiovascular safety: challenges in drug and device development and clinical application. Am Heart J, 164(4), 481–492. https://doi.org/10.1016/j.ahj.2012.07.019
Bates, Katherine E., Victoria L. Vetter, Jennifer S. Li, Susan Cummins, Fernando Aguel, Christopher Almond, Anne M. Dubin, et al. “Pediatric cardiovascular safety: challenges in drug and device development and clinical application.Am Heart J 164, no. 4 (October 2012): 481–92. https://doi.org/10.1016/j.ahj.2012.07.019.
Bates KE, Vetter VL, Li JS, Cummins S, Aguel F, Almond C, et al. Pediatric cardiovascular safety: challenges in drug and device development and clinical application. Am Heart J. 2012 Oct;164(4):481–92.
Bates, Katherine E., et al. “Pediatric cardiovascular safety: challenges in drug and device development and clinical application.Am Heart J, vol. 164, no. 4, Oct. 2012, pp. 481–92. Pubmed, doi:10.1016/j.ahj.2012.07.019.
Bates KE, Vetter VL, Li JS, Cummins S, Aguel F, Almond C, Dubin AM, Elia J, Finkle J, Hausner EA, Joseph F, Karkowsky AM, Killeen M, Lemacks J, Mathis L, McMahon AW, Pinnow E, Rodriguez I, Stockbridge NL, Stockwell M, Tassinari M, Krucoff MW. Pediatric cardiovascular safety: challenges in drug and device development and clinical application. Am Heart J. 2012 Oct;164(4):481–492.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

October 2012

Volume

164

Issue

4

Start / End Page

481 / 492

Location

United States

Related Subject Headings

  • Product Surveillance, Postmarketing
  • Patient Safety
  • Models, Animal
  • Humans
  • Government Regulation
  • Equipment Design
  • Electrocardiography
  • Drug Evaluation, Preclinical
  • Drug Design
  • Dose-Response Relationship, Drug