Calcium Channel Blockers and Clinical Outcomes in Patients with Continuous-flow Left Ventricular Assist Devices

Overview

Journal ESC Heart Fail

Date 2023 Nov 15

PMID 37967837

Authors

Hongtao Tie

Zhenhan Li

Henryk Welp

Avirup Guha

Cesar Caraballo

Heinz Deschka

Rui Shi

Xiaoqing Zheng

Sven Martens

Jurgen Sindermann

Dan Chen

Qingchen Wu

Sabrina Martens

Affiliations

Soon will be listed here.

Abstract

Aims: Current guidelines suggest calcium channel blockers (CCBs) as the second or third option for blood pressure management in patients with left ventricular assist device (LVAD). However, the clinical outcomes of patients with LVAD who receive CCBs remain unclear. Our study aims to analyse the association of CCBs with clinical outcomes in patients after LVAD implantation.

Methods And Results: This is a retrospective analysis based on the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) from 2006 to 2017, and adult patients who were alive with LVAD and CCB treatment information at 6 months after implantation were included. Among 10 717 patients, 1369 received CCBs 6 months after implantation, and there was an increasing trend of CCB use after LVAD. Patients receiving CCB therapy at 6 months had a similar 5 year survival rate to those not receiving CCB [49.6%, 95% confidence interval (CI): 47.5-51.7% vs. 51.1%, 95% CI: 45.3-56.7%]. In both Cox and competing risk regressions after adjusting for confounding factors, CCB treatment at 6 months after implantation was not associated with long-term mortality [hazard ratio (HR): 1.03, 95% CI: 0.91-1.17, P = 0.624 and subdistribution HR (SHR): 1.07, 95% CI: 0.95-1.22, P = 0.260]. Consistently, in time-varying models, CCB treatment was not linked to long-term mortality (HR: 0.97, 95% CI: 0.87-1.09, P = 0.682 and SHR: 1.05, 95% CI: 0.94-1.18, P = 0.359). This null association remained in subgroup analysis according to device strategy and propensity-matching analyses. Neurological dysfunction, stroke, bleeding, rehospitalization, and renal dysfunction were more likely to occur among those with CCB when compared with those without CCB treatment.

Conclusions: In patients with LVAD, CCB therapy fails to show benefits in long-term survival and is associated with increased incidences of neurological dysfunction, bleeding, renal dysfunction, and rehospitalization.

Citing Articles

Calcium channel blockers and clinical outcomes in patients with continuous-flow left ventricular assist devices.

Tie H, Li Z, Welp H, Guha A, Caraballo C, Deschka H ESC Heart Fail. 2023; 11(1):271-281.

PMID: 37967837 PMC: 10804166. DOI: 10.1002/ehf2.14576.

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