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

Abstract

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. 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. 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. 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.