Abstract 12180: Post-Implant Beta Blocker Use and Late Right Heart Failure After LVAD Implantation: An STS-INTERMACS Analysis

Abstract

Introduction: Late right heart failure (LRHF) after left ventricular assist device (LVAD) implant is associated with increased morbidity and mortality. Whether post-implant beta-blocker (BB) use can mitigate the incidence of LRHF is unknown. Methods: We queried the STS-INTERMACS registry from 2008-2018 for adults receiving a primary, continuous-flow LVAD and surviving to 3 months without ongoing RHF, defined as presence of a right ventricular assist device (RVAD) or inotropic support. We excluded patients with atypical LVAD cannulation, bridge-to-recovery strategy, ongoing renal replacement therapy, or missing BB status at 3 months. At 3 months post-implant, patients receiving BB were propensity-matched 1:1 to those not receiving BB using a nearest-neighbor method without replacement. The primary outcome was a composite of all-cause mortality or LRHF, including the need for RVAD, inotropic support, or hospitalization for RHF or fluid overload, and was compared between groups with the Kaplan-Meier method and log-rank testing. Results: Among 14,317 patients meeting inclusion criteria, 4,880 patients receiving BB at 3 months were matched with 4,880 not receiving BB. Baseline covariates were well-balanced (Figure, panel A) and 11.2% of patients experienced early RHF. Over 3-years of follow up, patients receiving BB had a lower incidence of the primary outcome hazard ratio (HR) 0.91 (95% CI: 0.85-0.97), p=0.007 (Figure, panel B). This difference was driven primarily by lower rates of hospitalization for RHF or fluid overload (HR 0.83, 95% CI: 0.72-0.95, p=0.008) and all-cause mortality (HR 0.91, 95% CI: 0.82-1.02, p=0.11) while rates of late RVAD or inotropic support were similar. Conclusions: In this retrospective, propensity-matched analysis, the use of beta blockers after LVAD implant was associated with a modest reduction in the composite of all-cause mortality and LRHF. These data suggest BB may mitigate LRHF and should be confirmed with prospective studies.