Heart failure medications prescribed at discharge for patients with left ventricular assist devices.
BACKGROUND
Real-world use of traditional heart failure (HF) medications for patients with left ventricular assist devices (LVADs) is not well known.


METHODS
We conducted a retrospective, observational analysis of 1,887 advanced HF patients with and without LVADs from 32 LVAD hospitals participating in the Get With The Guidelines-Heart Failure registry from January 2009 to March 2015. We examined HF medication prescription at discharge, temporal trends, and predictors of prescription among patients with an in-hospital (n = 258) or prior (n = 171) LVAD implant, and those with advanced HF but no LVAD, as defined by a left ventricular ejection fraction ≤25% and in-hospital receipt of intravenous inotropes or vasopressin receptor antagonists (n = 1,458).


RESULTS
For β-blocker and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB), discharge prescriptions were 58.9% and 53.5% for new LVAD patients, 53.8% and 42.9% for prior LVAD patients, and 73.4% and 63.2% for patients without LVAD support, respectively (both P < .0001). Aldosterone antagonist prescription quadrupled among LVAD patients during the study period (P < .0001), whereas ACEI/ARB use decreased nearly 20 percentage points (60.0% to 41.4%, P = .0003). In the multivariable analysis of LVAD patients, patient age was inversely associated with β-blocker, ACEI/ARB, and aldosterone antagonist prescription.


CONCLUSIONS
Traditional HF therapies were moderately prescribed at discharge to patients with LVADs and were more frequently prescribed to patients with advanced HF without LVAD support. Moderate prescription rates suggest clinical uncertainty in the use of antiadrenergic medication in this population. Further research is needed on the optimal medical regimen for patients with LVADs.
Stanford University, Stanford, CA. Electronic address: jbaras@stanford.edu.
Jacqueline Baras
JB
Shreibati
Duke University, Durham, NC.
Shubin
S
Sheng
Ronald Reagan-UCLA Medical Center, Los Angeles, CA.
Gregg C
GC
Fonarow
Duke University, Durham, NC.
Adam D
AD
DeVore
Northwestern University, Chicago, IL.
Clyde W
CW
Yancy
Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA.
Deepak L
DL
Bhatt
Mayo Clinic, Rochester, MN.
Phillip
P
Schulte
Duke University, Durham, NC.
Eric D
ED
Peterson
Duke University, Durham, NC.
Adrian
A
Hernandez
Stanford University, Stanford, CA.
Paul A
PA
Heidenreich
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D065092:Antidiuretic Hormone Receptor Antagonists / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D012042:Registries; D012189:Retrospective Studies; D013318:Stroke Volume
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D065092:Antidiuretic Hormone Receptor Antagonists; D002316:Cardiotonic Agents; D000451:Mineralocorticoid Receptor Antagonists