Heart failure medications prescribed at discharge for patients with left ventricular assist devices

Jacqueline Baras Shreibati, Shubin Sheng, Gregg C. Fonarow, Adam D. DeVore, Clyde W. Yancy, Deepak L. Bhatt, Phillip Schulte, Eric D. Peterson, Adrian Hernandez, Paul A. Heidenreich

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)99-106
Number of pages8
JournalAmerican Heart Journal
Volume179
DOIs
StatePublished - Sep 1 2016

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Heart-Assist Devices
Patient Discharge
Heart Failure
Prescriptions
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Mineralocorticoid Receptor Antagonists
Adrenergic Antagonists
Stroke Volume
Uncertainty
Registries

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Shreibati, J. B., Sheng, S., Fonarow, G. C., DeVore, A. D., Yancy, C. W., Bhatt, D. L., ... Heidenreich, P. A. (2016). Heart failure medications prescribed at discharge for patients with left ventricular assist devices. American Heart Journal, 179, 99-106. https://doi.org/10.1016/j.ahj.2016.06.011

Heart failure medications prescribed at discharge for patients with left ventricular assist devices. / Shreibati, Jacqueline Baras; Sheng, Shubin; Fonarow, Gregg C.; DeVore, Adam D.; Yancy, Clyde W.; Bhatt, Deepak L.; Schulte, Phillip; Peterson, Eric D.; Hernandez, Adrian; Heidenreich, Paul A.

In: American Heart Journal, Vol. 179, 01.09.2016, p. 99-106.

Research output: Contribution to journalArticle

Shreibati, JB, Sheng, S, Fonarow, GC, DeVore, AD, Yancy, CW, Bhatt, DL, Schulte, P, Peterson, ED, Hernandez, A & Heidenreich, PA 2016, 'Heart failure medications prescribed at discharge for patients with left ventricular assist devices', American Heart Journal, vol. 179, pp. 99-106. https://doi.org/10.1016/j.ahj.2016.06.011
Shreibati, Jacqueline Baras ; Sheng, Shubin ; Fonarow, Gregg C. ; DeVore, Adam D. ; Yancy, Clyde W. ; Bhatt, Deepak L. ; Schulte, Phillip ; Peterson, Eric D. ; Hernandez, Adrian ; Heidenreich, Paul A. / Heart failure medications prescribed at discharge for patients with left ventricular assist devices. In: American Heart Journal. 2016 ; Vol. 179. pp. 99-106.
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abstract = "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.",
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AU - Sheng, Shubin

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AU - Yancy, Clyde W.

AU - Bhatt, Deepak L.

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N2 - 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.

AB - 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.

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