(840) Comparison of Heart Failure Therapy Implementation in Patients with and without Temporary Right Ventricular Assist Device Following HeartMate 3 LVAD Implantation: A 6-Month Post-Implant Comparison

PurposeThe utilization of guideline directed medical therapy (GDMT) in left ventricular assist device (LVAD) patients has not been well studied. We evaluated the use of GDMT in patients following HeartMate 3 LVAD implantation stratified by severe initial right ventricular failure requiring temporary right ventricular assist device (tRVAD).MethodsWe retrospectively analyzed a single-center convenience sample of patients from 2018-2021 who required both LVAD with tRVAD (N=23) or LVAD alone (N=58). We compared rates of GDMT implementation at 6 months post-implant. GDMT implementation was at the discretion of the provider. GDMT doses were expressed as daily total mg equivalents of valsartan (ARB), metoprolol (beta-blocker), spironolactone (MRA), hydralazine, and furosemide (diuretic), then compared using Mann-Whitney test and proportions by Fischer's exact test.ResultsAt 6 month visit, median age (64 vs. 53 yrs), female sex (24% vs. 43%), creatinine (1.3 vs. 1.0 mg/dL), and mean arterial pressure (89 vs. 87 mmHg) were reported in LVAD alone versus LVAD-tRVAD, respectively. No significant differences in doses of ARB (52 vs. 80 mg, P=0.36), MRA (25 vs. 25 mg, P=0.93) and diuretic (60 vs. 50 mg, P=0.76) were observed in LVAD alone compared to LVAD-tRVAD (Figure). Significantly greater beta-blocker dosage and utilization was observed in the LVAD alone group (50 vs. 25 mg, 53% vs. 17%, P<0.05 for both). Hydralazine was utilized more in LVAD alone group (56% [N=33] vs. 26% [N=6], P=0.02), though did not significantly differ by dose (100 vs 65 mg, P=0.43). Significantly greater digoxin utilization was observed in the LVAD-tRVAD group (65% vs 24%, P=0.005).ConclusionSignificant differences in GDMT utilization were observed between LVAD patients with and without tRVAD post implant. The longitudinal impact of these findings on clinical outcomes needs further investigation. The utilization of guideline directed medical therapy (GDMT) in left ventricular assist device (LVAD) patients has not been well studied. We evaluated the use of GDMT in patients following HeartMate 3 LVAD implantation stratified by severe initial right ventricular failure requiring temporary right ventricular assist device (tRVAD). We retrospectively analyzed a single-center convenience sample of patients from 2018-2021 who required both LVAD with tRVAD (N=23) or LVAD alone (N=58). We compared rates of GDMT implementation at 6 months post-implant. GDMT implementation was at the discretion of the provider. GDMT doses were expressed as daily total mg equivalents of valsartan (ARB), metoprolol (beta-blocker), spironolactone (MRA), hydralazine, and furosemide (diuretic), then compared using Mann-Whitney test and proportions by Fischer's exact test. At 6 month visit, median age (64 vs. 53 yrs), female sex (24% vs. 43%), creatinine (1.3 vs. 1.0 mg/dL), and mean arterial pressure (89 vs. 87 mmHg) were reported in LVAD alone versus LVAD-tRVAD, respectively. No significant differences in doses of ARB (52 vs. 80 mg, P=0.36), MRA (25 vs. 25 mg, P=0.93) and diuretic (60 vs. 50 mg, P=0.76) were observed in LVAD alone compared to LVAD-tRVAD (Figure). Significantly greater beta-blocker dosage and utilization was observed in the LVAD alone group (50 vs. 25 mg, 53% vs. 17%, P<0.05 for both). Hydralazine was utilized more in LVAD alone group (56% [N=33] vs. 26% [N=6], P=0.02), though did not significantly differ by dose (100 vs 65 mg, P=0.43). Significantly greater digoxin utilization was observed in the LVAD-tRVAD group (65% vs 24%, P=0.005). Significant differences in GDMT utilization were observed between LVAD patients with and without tRVAD post implant. The longitudinal impact of these findings on clinical outcomes needs further investigation.