The Benefit of Mean Arterial Pressure Control Using Heart Failure Medical Therapies in Patients Supported by HeartMate 3 LVADs

Abstract

Introduction Current recommendations for hypertension management in patients with LVADs include the use of neurohormonal antagonists, such as RAAS inhibitors and beta-blockers (BB). HeartMate3 (HM3) LVAD device package insert recommends a goal MAP Methods A single-center, retrospective chart review was conducted for patients with HM3 implantation from 2015-2018. Demographic, medication, laboratory and clinical outcomes data were extracted from an internal database. Patients who died prior to discharge were excluded. Results Patients (n=87) were predominantly Caucasian (82.8%) men (71.3%) with a mean age of 58.1 ± 10.9 years. Co-morbidities included DM (41.4%), hypertension (52.9%), CKD (21.8%) and arrhythmias (62.1%). A MAP of 80-90 mm Hg was achieved in 32% of patients at discharge and in 51% at 6-months (Figure 1A). At discharge, 11.5% of patients were on a RAAS inhibitor, BB and mineralocorticoid receptor antagonists (MRA) compared to 28.7% at 6-months (Figure 1B). Creatinine and MAP did not differ by drug class. The secondary composite outcome at 6-months occurred in 35.8% of patients overall (3 events in patients treated with a combination of RAAS inhibitor with BB and MRA vs 13 in patients without any medical therapy). Conclusion There was an overall increase in systemic blood pressure following surgical recovery 6-months post-HM3 implant, with more than 90% of the cohort sustaining a MAP >80 mm Hg and 40% >90 mm Hg. GDMT with a RAAS inhibitor, BB and MRA was low at discharge (11.5%) with only marginal improvement at 6-months (28.7%), despite adequate MAPs. Factors limiting the titration of GDMT in this population, despite adequate MAP control, warrants further quality improvement investigation.