title: Assessment of the heart failure pharmacotherapy of patients with continuous flow left-ventricular assist devices.
abstract: OBJECTIVE
  The purpose of this project was to characterize the use of heart failure medications during the first year after left-ventricular assist device (LVAD) implantation.
  
  
  METHODS
  All patients who received a HeartMate II at our institution between January 1, 2007, and August 1, 2009, and were followed by our multidisciplinary team for at least 6 months were eligible for inclusion. Use of heart failure medications, including dosages, was collected for each patient prior to LVAD implantation, at time of discharge, and at each subsequent monthly office visit for up to 1 year after implantation. The primary end point was the prescription rate for each medication class at discharge. Secondary end points included the use and dosage of these agents during follow up.
  
  
  RESULTS
  A total of 28 patients were included (mean age = 50±11.5 years; sex 75% male; race 57.1% white; bridge-to-transplant rate 25%). There was a statistically significant decrease in use of digoxin (42.9% vs. 7.1%), spironolactone (50% vs. 17.9%), nitrates (39.3% vs. 7.1%), and milrinone (71.4% vs. 3.6%) postimplantation compared with baseline (p<0.05, for all comparisons). More than 50% of patients received vasodilators, beta-blockers, and hydralazine both preimplantation and postimplantation (p>0.05 for each class). Furthermore, more patients reached target doses of beta-blockers (0% vs. 28.6%; p=0.04) after LVAD implantation.
  
  
  CONCLUSIONS
  Our pilot study shows consistent prescription of heart failure pharmacotherapy in LVAD patients at our institution, with more patients able to tolerate target doses of beta-blockers.
authors.affiliation: Cardiovascular Intensive Care Unit, Department of Pharmacy Services, Henry Ford Hospital, Detroit, Michigan 48201, USA. djennin1@hfhs.org
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Jennings
authors.forename: Mathew C
authors.initials: MC
authors.lastname: Jones
authors.forename: David E
authors.initials: DE
authors.lastname: Lanfear
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors