Abstract 12: Heart Failure Medications Prescribed at Discharge for Patients With Left Ventricular Assist Devices

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Jacqueline Baras Shreibati ◽  
Shubin Sheng ◽  
Gregg C Fonarow ◽  
Adam D DeVore ◽  
Clyde W Yancy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Beta Blocker ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Ejection ◽  
Ventricular Assist ◽  
Aldosterone Antagonist ◽  
Factors Associated ◽  
Left Ventricular Assist ◽  
Lvad Support

Background: The longitudinal success of the heart failure (HF) patient with a left ventricular assist device (LVAD) depends on medications to maintain the device, such as antithrombotic agents to prevent pump thrombosis and antihypertensives to reduce stroke risk. However, the role of traditional, evidence-based HF medications for patients with concurrent LVAD support is not well known. This study aimed to determine use, temporal trends, and factors associated with prescription of HF medications at discharge among patients with advanced HF with and without LVADs, and to examine patient and hospital-level factors associated with HF medication prescription among LVAD recipients. Methods: We conducted a retrospective, observational analysis of 4,580 advanced HF patients from 215 hospitals participating in the Get With The Guidelines-Heart Failure registry from January 2009 to March 2015. We examined patterns of HF medication use at hospital discharge among patients with an in-hospital (n=258) or prior (n=326) LVAD implant, and those with advanced HF without an LVAD, as defined by a reduced left ventricular ejection fraction and intravenous inotrope or vasopressin antagonist receipt (n=3,996). Results: For beta-blocker and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACE/ARB), discharge prescriptions were 58.9% and 53.5% for new LVAD recipients, 62.9% and 51.4% for prior LVAD recipients, and 78.7% and 60.7% for patients without LVAD support, respectively (p<0.0001 and p=0.0005). There was no significant difference in aldosterone antagonist use among the three groups (p=0.23) but its use quadrupled among LVAD patients during the study period (p<0.0001, see figure). Approximately 54% of new and prior LVAD patients and 66% of patients without an LVAD were discharged on two of the three HF medications (p<0.0001). In the multivariable analysis of LVAD patients, patient age was inversely associated with beta-blocker, ACE/ARB, and aldosterone antagonist use. Conclusion: Traditional HF therapies are commonly prescribed to LVAD recipients, although less frequently than to advanced HF patients without LVAD support. Aldosterone antagonists are prescribed increasingly to LVAD patients. Further research is needed on the optimal medical regimen for patients with LVADs.

Abstract W P163: Ischemic and Hemorrhagic Cerebrovascular Events after Left Ventricular Assist Devices

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Pouya Tahsili-Fahadan ◽  
David R Curfman ◽  
Albert A Davis ◽  
Noushin Yahyavi-Firouz-Abadi ◽  
Michael E Nassif ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
Advanced Heart Failure ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Cerebrovascular Events ◽  
Left Ventricular Assist ◽  
Lvad Support

Introduction: Left ventricular assist devices (LVADs) are increasingly implanted for advanced heart failure either as a bridge to transplantation (BTT) or destination therapy (DT). The reported incidence of cerebrovascular events (CVE) following LVAD is 8-25%. The effects of medical comorbidities and perioperative events on the development of CVE are unclear. Methods: CVEs were retrospectively identified from the Barnes-Jewish Hospital LVAD database consisting of 373 patients with mean LVAD support of 13.5 months (range 0 days-8.2 years); Heartmate II 87%, Heartware 13%. Demographic, clinical, and outcome data were collected and analyzed in patients with and without CVE using standard statistical methods. Results: CVE occurred in 71 patients (19%) at a rate of 0.17 per patient-year 24.5±30.7 months after implantation. Coronary artery disease (P=0.007), diabetes mellitus (P=0.02) and LVAD indication of DT (P=0.04) were more common in patients with CVEs. Duration of cardiopulmonary bypass, hospital length of stay and incidence of bacteremia were not different between those with early CVE (within 30 days of implantation, 35%) and without CVE. CVEs were ischemic (ICVE) in 35 (49%), hemorrhagic (HCVE, including intracerebral, subarachnoid, and subdural) in 26 (37%), and both in 10 (14%). Patients with ICVE and HCVE did not differ in demographic variables, pre-LVAD co-morbidities, post-LVAD complications, NIH Stroke Scale at time of event, or anti-thrombotic regimen (ATR), except that events in those on no ATR were only ischemic. Patients with HCVEs were more likely to be discharged with no ATR (P=0.015). Mortality was significantly higher in patients with CVE (59.1% vs. 29.2% in those without CVE) but did not differ by CVE type. In patients with CVE, 57.1% of deaths were secondary to the CVE (ICVE 25%, HCVE 93.7%, P<0.001). Among BTT patients, only 14.6% with CVE underwent transplantation vs. 39.8% without CVE (P =0.002). Conclusions: CVE remains a serious complication of LVAD support for advanced heart failure and is associated with increased mortality and lower rates of heart transplantation. Further investigations to identify risk factors for CVEs in LVAD patients and potential preventive measures including optimal ATRs are warranted.

scholarly journals Slope of the Anterior Mitral Valve Leaflet: A New Measurement of Left Ventricular Unloading for Left Ventricular Assist Devices and Systolic Dysfunction

2014 ◽  
Vol 41 (3) ◽  
pp. 262-272 ◽  
Author(s):  
Sara C. Martinez ◽  
Elisa A. Bradley ◽  
Eric L. Novak ◽  
Ravi Rasalingam ◽  
Ari M. Cedars ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Mitral Valve ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Ejection ◽  
Valve Leaflet ◽  
Mitral Valve Leaflet ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Left ventricular assist device (LVAD)-supported patients are evaluated routinely with use of transthoracic echocardiography. Values of left ventricular unloading in this unique patient population are needed to evaluate LVAD function and assist in patient follow-up. We introduce a new M-mode measurement, the slope of the anterior mitral valve leaflet (SLAM), and compare its efficacy with that of other standard echocardiographically evaluated values for left ventricular loading, including E/e′ and pulmonary artery systolic pressures. Average SLAM values were determined retrospectively for cohorts of random, non-LVAD patients with moderately to severely impaired left ventricular ejection fraction (LVEF) (&lt;0.35, n=60). In addition, pre- and post-LVAD implantation echocardiographic images of 81 patients were reviewed. The average SLAM in patients with an LVEF &lt;0.35 was 11.6 cm/s (95% confidence interval, 10.4–12.8); SLAM had a moderately strong correlation with E/e′ in these patients. Implantation of LVADs significantly increased the SLAM from 7.3 ± 2.44 to 14.7 ± 5.01 cm/s (n=42, P &lt;0.0001). The LVAD-supported patients readmitted for exacerbation of congestive heart failure exhibited decreased SLAM from 12 ± 3.93 to 7.3 ± 3.5 cm/s (n=6, P=0.041). In addition, a cutpoint of 10 cm/s distinguished random patients with LVEF &lt;0.35 from those in end-stage congestive heart failure (pre-LVAD) with an 88% sensitivity and a 55% specificity. Evaluating ventricular unloading in LVAD patients remains challenging. Our novel M-mode value correlates with echocardiographic values of left ventricular filling in patients with moderate-to-severe systolic function and dynamically improves with the ventricular unloading of an LVAD.

scholarly journals Reverse Remodeling With Left Ventricular Assist Devices

2021 ◽  
Vol 128 (10) ◽  
pp. 1594-1612 ◽  
Author(s):  
Daniel Burkhoff ◽  
Veli K. Topkara ◽  
Gabriel Sayer ◽  
Nir Uriel
Keyword(s):  
Heart Failure ◽  
Clinical Outcomes ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Reverse Remodeling ◽  
Clinical Aspects ◽  
Left Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
Lvad Support

This review provides a comprehensive overview of the past 25+ years of research into the development of left ventricular assist device (LVAD) to improve clinical outcomes in patients with severe end-stage heart failure and basic insights gained into the biology of heart failure gleaned from studies of hearts and myocardium of patients undergoing LVAD support. Clinical aspects of contemporary LVAD therapy, including evolving device technology, overall mortality, and complications, are reviewed. We explain the hemodynamic effects of LVAD support and how these lead to ventricular unloading. This includes a detailed review of the structural, cellular, and molecular aspects of LVAD-associated reverse remodeling. Synergisms between LVAD support and medical therapies for heart failure related to reverse remodeling, remission, and recovery are discussed within the context of both clinical outcomes and fundamental effects on myocardial biology. The incidence, clinical implications and factors most likely to be associated with improved ventricular function and remission of the heart failure are reviewed. Finally, we discuss recognized impediments to achieving myocardial recovery in the vast majority of LVAD-supported hearts and their implications for future research aimed at improving the overall rates of recovery.

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