Abstract 12373: Clinical Outcomes in Patients With Left Ventricular Assist Device on Guideline Directed Medical Therapy: A Propensity Score Matched Analysis

Abstract

Introduction: We investigate the benefit of Guideline Directed Medical Therapy [GDMT] in patients with Left Ventricular Assist Device (LVAD) using an insurance claims database. Methods: We queried Trinetx US collaborative network for patients with LVAD and created two groups; those who received ≥2 prescriptions of any GDMT medication and who did not receive any GDMT after implantation. These were matched by Propensity Score Matching (PSM) for age, race, sex, BMI, LVEF, SBP, DBP, ischemic heart disease, hypertension, disorder of pulmonary circulation, chronic kidney disease (CKD) and acute kidney injury (AKI). All diagnosis were identified using ICD codes. Patient demographics, LVEF, BMI, SBP and DBP were recorded as reported by TriNetX. We looked at primary and secondary outcome measures starting 90 days until 10 years post implantation, primary being all cause mortality and secondary being risk of decompensated heart failure, hypotension, AKI, odds of receiving heart transplant and LVAD explant. Results: We had 4514 patients with LVAD on GDMT and 687 without GDMT. After PSM, we had 651 patients in each group. Both were matched by PSM with Standardized mean difference (SMD) < 0.1 for all variables. Those with LVAD on GDMT had lower risk of all-cause mortality [233 (37.28%)] compared to those not on GDMT [157 (56.29%)] (hazard ratio [HR] 0.30, 95% confidence interval [CI] 0.24-0.37, P < 0.0001) [Figure 1] but at a higher risk of decompensation (RR 2.74, 95% CI 2.19-3.42), hypotension (RR 3.58, 95% CI 2.73 - 4.69) and AKI (RR 2.64, 95% CI 2.23-3.18). Patients receiving heart transplant and LVAD explant had higher odds of being on GDMT [Odds Ratio [OR], 95% CI: 2.86, 1.87 - 4.37; 4.29, 2.13 - 8.63, respectively). Conclusions: LVAD patients on GDMT have lower all-cause mortality, higher odds of receiving heart transplant and LVAD explant starting 90 days post implant. However, for reasons not clear to us, they are also at higher risk of decompensation, hypotension and AKI.