Association between Angiotensin II Antagonism and Mortality after LVAD Implantation: A Multi-Center, Contemporary Analysis

Jessica N Schultz, B. Trachtenberg, J. Estep, K. Goodwin, R. Araujo, A. G.El Rafei, Tamas Alexy, Andrew W Shaffer, R. John, Rebecca J Cogswell

Research output: Contribution to journalArticle

Abstract

PURPOSE: To determine the association between ACEI/ARB use and post LVAD mortality in a large, multi-center, contemporary CF dataset inclusive of HeartMate 3 devices. METHODS: Patients at the two centers with a first time continuous flow (CF) LVAD implant with complete medication and survival outcome data were included in the analysis (total n=648). ACEI/ARB utilization was defined as ACEI or ARB use at discharge or within the first 3 months after LVAD implantation. A mutivariate cox regression was performed to test the association between ACEI/ARB use and post LVAD mortality. RESULTS: The mean age of the study cohort was 57 years (+/- 14), 45% were bridge to transplant (BTT), and 13% received HeartMate 3 devices. The median length of follow up for the analysis was 608 days. Sixty six percent of patients were on an ACEI or ARB in the 3 months after LVAD implantation. Use of either an ACEI or ARB was associated with an adjusted 35% reduction in the hazard rate of mortality on LVAD support (adjusted HR 0.65, 95% CI 0.48-0.87, p = 0.004). The final model was adjusted for sex, INTERMACS profile, BTT status, serum creatinine at the time of implant, serum albumin, and BMI. CONCLUSION: ACEI/ARB use was associated with reduced post LVAD mortality in this large, multi-center, contemporary CF dataset inclusive of HeartMate 3 devices. Whether or not tolerating an ACEI or ARB is a marker of a healthier LVAD patient or is the direct cause of improved outcomes remains to be proven.

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