371 - Phosphodiesterase Type 5 Inhibitor Use Does Not Affect Heart Failure Hospitalizations in Patients with Left Ventricular Assist Devices

Abstract

Purpose: Selective type 5 phosphodiesterase (PDE5) inhibitors are commonly used off-label in patients with continuous flow left ventricular assist devices (LVAD) for right ventricular afterload reduction. However, evidence supporting clinical benefit from PDE5 inhibitor use is weak. We sought to determine whether PDE5 inhibitor use in patients implanted with an LVAD, decreases the rate of subsequent heart failure hospitalizations post implantation. Methods: We retrospectively identified patients from the Advanced Heart Failure database who underwent implantation of a HeartMate II or a HeartWare HVAD between 1/1/2010 and 9/1/2015 and had at least one heart failure hospitalization through 9/15/2016. Cox-regression analysis was used to capture time to first heart failure hospitalization and the Andersen-Gill model was used to account for multiple readmissions for the same patient. Seventy-three subjects were followed post-implant through their clinical course and censored for explant, transfer to another institution, or death. Results: In our cohort, 14 subjects were never prescribed a PDE5 inhibitor and 59 were prescribed tadalafil or sildenafil. Both populations were similar in age, sex, BMI, ischemic cardiomyopathy, but differed by total days of ionotrope/ionotropic support post implant (Table 1). A total of 145 heart failure related hospitalizations occurred over the study period between 2010–2016. After adjusting for age, sex, BMI, INTERMACS profile, ischemic etiology, and ionotrope/ionotropic support post implant, PDE5 inhibitor use did not affect first time (HR: 1.32 (0.67–2.62); P = .426) or multiple (HR: 1.04 (0.71–1.51); P = .841) heart failure hospitalizations. Conclusion: PDE5 inhibitor use does not impact the rate of heart failure hospitalization in this population. Continued investigation of PDE5 inhibitor use on clinical end points is needed to guide use of this therapy in the LVAD population.Table 1Baseline CharacteristicsControlPDE5 inhibitorP-valueN1459Age (years)56.4 (11.3)57.0 (11.6).86Sex (%male)71.4%83.0%.32BMI (kg/m2)27.0 (5.0)30.0 (5.9).08INTERMACS profile.57121.4%11.9%221.4%32.2%335.7%42.4%421.4%10.2%ICM (%ischemic)35.7%37.0%.91Ionotrope/Ionotropic support post implant (days)5.5 (4.0–11.0)11.0 (6.0–18.0).006**Kruskal-Wallis test p-value for non-normal distribution. Open table in a new tab *Kruskal-Wallis test p-value for non-normal distribution.