Abstract 16087: Contemporary Use of Guideline Directed Heart Failure Medications in Patients With Centrifugal Durable Left Ventricular Assist Device

Abstract

Introduction: As societal guidelines have recently supported, our large-volume center has recently protocolized the use of guideline directed medical therapy <GDMT> in patients with left ventricular assist devices <LVAD> to promote ventricular recovery. Hypothesis: We sought to understand the use of, and opportunity to improve upon, GDMT use in the LVAD population.To describe contemporary utilization of comprehensive GDMT in the <HM3> LVAD population and to characterize patient factors associated with use of HF medical therapy utilizing a comprehensive GDMT score. Methods: We conducted retrospective of analysis of patients who had HM3 implanted at our center <N = 270> and had at least one ambulatory visit for HF in the prior 12 months. Baseline characteristics, laboratory test, acute care utilization and GDMT score data were extracted from the nearest date of the ambulatory encounter to the data extraction date that occurred on 9/23/22. GDMT score <range from 0 to 8> composition includes beta-blocker, ACEI/ARB [0 for none, 1 for <50% and 2 for ≥50% of max dose], MRA, SGLT2i, ARNI [0 for none and 2 for any dose] and ISDN/Hydra [0 for none and 1 for any dose]. Linear regression analyses of clinical variables associated with GDMT score were performed. Results: We observed mean score of 3.23 ± 1.7 with median of 3.0. In this study, mean age was 60, >70% were Caucasian male and mean eGFR was 62. 49% of total cohort [135] were on beta-blocker, 75% [202] on ARB/ACE/ARNI, 47% [127] on MRA, and only 15% [40] on SGLT2i and 20% [53] on ISDN/Hydralazine. Majority [~95%] do not have absolute contraindication to GDMT [based on MAP <65, eGFR <30, K> 5.0]. Adjusted multivariable regression analysis showed GDMT score </= 3 was associated with higher age [adjusted risk score of - 0.25 per every 10 years, 95% CI : -0.43 to - 0.65], higher MAP [adjusted risk score of - 0.19 per every 10 mmHg, 95% CI : -0.34 to - 0.03], and all-cause hospitalizations [adjusted risk score of - 0.23, 95% CI : -0.40 to - 0.06]. There was no significant association with gender, race, heart rate, NT-proBNP, eGFR, potassium and comorbidities. Conclusions: We identified significant opportunity to improve use of GDMT in the post LVAD population, with older age and frequent hospitalization being associated with worse GDMT use.