Thin Filament Cardiomyopathy: Natural History, Clinical Features, And Outcomes
HFSA ePoster Library. Saul T. 09/10/21; 343554; 313
Tatiana Saul
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Abstract
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Introduction: Guideline-directed medical therapy (GDMT) is well established in patients with heart failure with reduced ejection fraction (HFrEF) to decrease hospitalizations and mortality. There is less guidance for neurohormonal blockade (NHB) treatment in patients with a left ventricular assist device (LVAD). According to a recent study, neurohormonal blockade treatment is associated with improved survival and quality of life in LVAD patients. Thus, we sought to determine the utilization of NHB therapy including contraindications to its use in LVAD patients.
Methods: We used the electronic health record to retrospectively analyze adults who underwent continuous-flow LVAD implant at a single center from March 1, 2018 to October 1, 2020. Descriptive statistics were used to evaluate patients’ demographic characteristics and the proportion of patients prescribed NHB therapy, classified as beta-blockers (BB), ACE inhibitors (ACEi)/angiotensin receptor blockers (ARB)/angiotensin-receptor neprilysn inhibitor (ARNI), and mineralocorticoid receptor antagonists (MRA). The primary outcome was the proportion of patients on NHB at time of implant, discharge from index hospitalization, and 3 and 6 month follow-up. Secondary outcomes were barriers to medication utilization.
Results: 90 LVAD patients were included in the study. Average age at implant was 56.7, 73% were male, and 49% were white. The proportion of patients on NHB therapy is shown in Table 1. At 6 months, right ventricular dysfunction (RVD) was the most common barrier to beta-blocker therapy (40%). Chronic kidney disease (CKD) and hypotension were the most common barriers to ACEI/ARB/ARNI (18% and 10% respectively). CKD was the most common barrier to MRA therapy (15%).
Conclusion: The use of NHB therapies in LVAD patients is relatively low. Although barriers to therapy include hypotension, renal impairment and RVD, many patients were not prescribed NHB therapies despite having no absolute or relative contraindications.
Methods: We used the electronic health record to retrospectively analyze adults who underwent continuous-flow LVAD implant at a single center from March 1, 2018 to October 1, 2020. Descriptive statistics were used to evaluate patients’ demographic characteristics and the proportion of patients prescribed NHB therapy, classified as beta-blockers (BB), ACE inhibitors (ACEi)/angiotensin receptor blockers (ARB)/angiotensin-receptor neprilysn inhibitor (ARNI), and mineralocorticoid receptor antagonists (MRA). The primary outcome was the proportion of patients on NHB at time of implant, discharge from index hospitalization, and 3 and 6 month follow-up. Secondary outcomes were barriers to medication utilization.
Results: 90 LVAD patients were included in the study. Average age at implant was 56.7, 73% were male, and 49% were white. The proportion of patients on NHB therapy is shown in Table 1. At 6 months, right ventricular dysfunction (RVD) was the most common barrier to beta-blocker therapy (40%). Chronic kidney disease (CKD) and hypotension were the most common barriers to ACEI/ARB/ARNI (18% and 10% respectively). CKD was the most common barrier to MRA therapy (15%).
Conclusion: The use of NHB therapies in LVAD patients is relatively low. Although barriers to therapy include hypotension, renal impairment and RVD, many patients were not prescribed NHB therapies despite having no absolute or relative contraindications.
| No. (%) | Baseline | Discharge | 3 Months | 6 Months |
| None | 10 (11%) | 32 (36%) | 15 (17%) | 9 (10%) |
| All 3 Classes | 26 (29%) | 1 (1%) | 11 (12%) | 8 (9%) |
| ACEi/ARB/ARNI + MRA | 12 (13%) | 13 (15%) | 24 (27%) | 25 (28%) |
| ACEi/ARB/ARNI + BB | 8 (9%) | 1 (1%) | 2 (2%) | 3 (3%) |
| MRA + BB | 9 (10%) | 6 (7%) | 7 (8%) | 14 (16%) |
| BB | 8 (9%) | 5 (6%) | 4 (4%) | 4 (5%) |
| MRA | 13 (14%) | 30 (34%) | 23 (26%) | 19 (22%) |
| ACEi/ARB/ARNI | 4 (4%) | 0 (0%) | 4 (4%) | 6 (7%) |
Introduction: Guideline-directed medical therapy (GDMT) is well established in patients with heart failure with reduced ejection fraction (HFrEF) to decrease hospitalizations and mortality. There is less guidance for neurohormonal blockade (NHB) treatment in patients with a left ventricular assist device (LVAD). According to a recent study, neurohormonal blockade treatment is associated with improved survival and quality of life in LVAD patients. Thus, we sought to determine the utilization of NHB therapy including contraindications to its use in LVAD patients.
Methods: We used the electronic health record to retrospectively analyze adults who underwent continuous-flow LVAD implant at a single center from March 1, 2018 to October 1, 2020. Descriptive statistics were used to evaluate patients’ demographic characteristics and the proportion of patients prescribed NHB therapy, classified as beta-blockers (BB), ACE inhibitors (ACEi)/angiotensin receptor blockers (ARB)/angiotensin-receptor neprilysn inhibitor (ARNI), and mineralocorticoid receptor antagonists (MRA). The primary outcome was the proportion of patients on NHB at time of implant, discharge from index hospitalization, and 3 and 6 month follow-up. Secondary outcomes were barriers to medication utilization.
Results: 90 LVAD patients were included in the study. Average age at implant was 56.7, 73% were male, and 49% were white. The proportion of patients on NHB therapy is shown in Table 1. At 6 months, right ventricular dysfunction (RVD) was the most common barrier to beta-blocker therapy (40%). Chronic kidney disease (CKD) and hypotension were the most common barriers to ACEI/ARB/ARNI (18% and 10% respectively). CKD was the most common barrier to MRA therapy (15%).
Conclusion: The use of NHB therapies in LVAD patients is relatively low. Although barriers to therapy include hypotension, renal impairment and RVD, many patients were not prescribed NHB therapies despite having no absolute or relative contraindications.
Methods: We used the electronic health record to retrospectively analyze adults who underwent continuous-flow LVAD implant at a single center from March 1, 2018 to October 1, 2020. Descriptive statistics were used to evaluate patients’ demographic characteristics and the proportion of patients prescribed NHB therapy, classified as beta-blockers (BB), ACE inhibitors (ACEi)/angiotensin receptor blockers (ARB)/angiotensin-receptor neprilysn inhibitor (ARNI), and mineralocorticoid receptor antagonists (MRA). The primary outcome was the proportion of patients on NHB at time of implant, discharge from index hospitalization, and 3 and 6 month follow-up. Secondary outcomes were barriers to medication utilization.
Results: 90 LVAD patients were included in the study. Average age at implant was 56.7, 73% were male, and 49% were white. The proportion of patients on NHB therapy is shown in Table 1. At 6 months, right ventricular dysfunction (RVD) was the most common barrier to beta-blocker therapy (40%). Chronic kidney disease (CKD) and hypotension were the most common barriers to ACEI/ARB/ARNI (18% and 10% respectively). CKD was the most common barrier to MRA therapy (15%).
Conclusion: The use of NHB therapies in LVAD patients is relatively low. Although barriers to therapy include hypotension, renal impairment and RVD, many patients were not prescribed NHB therapies despite having no absolute or relative contraindications.
| No. (%) | Baseline | Discharge | 3 Months | 6 Months |
| None | 10 (11%) | 32 (36%) | 15 (17%) | 9 (10%) |
| All 3 Classes | 26 (29%) | 1 (1%) | 11 (12%) | 8 (9%) |
| ACEi/ARB/ARNI + MRA | 12 (13%) | 13 (15%) | 24 (27%) | 25 (28%) |
| ACEi/ARB/ARNI + BB | 8 (9%) | 1 (1%) | 2 (2%) | 3 (3%) |
| MRA + BB | 9 (10%) | 6 (7%) | 7 (8%) | 14 (16%) |
| BB | 8 (9%) | 5 (6%) | 4 (4%) | 4 (5%) |
| MRA | 13 (14%) | 30 (34%) | 23 (26%) | 19 (22%) |
| ACEi/ARB/ARNI | 4 (4%) | 0 (0%) | 4 (4%) | 6 (7%) |
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