Guideline directed-medical therapy for heart failure within 3 months post LVAD implant and rehospitalization

BACKGROUND: Guideline-directed medical therapy (GDMT) is the foundation of pharmacologic management in HF with reduced ejection fraction offering mortality and morbidity benefits. GDMT use in patients supported by durable LVADs remains inconsistent.

METHODS: This is a retrospective, non-interventional, single-center cohort study conducted in adult patients (≥18 years) who underwent durable LVAD implantation between January 2009 and October 2024. GDMT was defined as the prescription of at least three of the following medication classes: beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), MRAs, and SGLT2i. Patients were divided into two groups GDMT group: ≥3 GDMT and Non-GDMT group: <3 GDMT. The aim of the study was to evaluate the association between the use of GDMT within 3 months after LVAD implantation and clinical outcomes, including all-cause hospital readmission, and 12-month mortality.

RESULTS: A total of 220 patients were included in the final analysis. Of these, 49 patients (24.9%) received ≥3 classes of GDMT, while 171 patients (75.1%) received fewer than three agents. Baseline demographic and clinical characteristics showed higher creatinine, AST and lower hemoglobin on Non GDMT group. The mean age was similar between groups. Patients receiving GDMT exhibited lower NT-pro BNP levels during right heart catheterization at follow-up (1218±1025 pg/mL vs. 2051±2598 pg/mL, p=0.01). During the 12-month follow-up period, all-cause rehospitalization occurred less frequently among patients receiving GDMT (71.4% vs. 88.5%, p=0.004). In multivariable logistic regression analysis the use of GDMT within 3 months after LVAD implantation was independently associated with 62% lower odds of rehospitalization (OR 0.38, 95% CI 0.16-0.91, p=0.03).

CONCLUSION: GDMT within 3 months post-implantation was associated with significantly fewer hospital readmissions for any cause. A favorable but non-significant trend toward lower 12-month mortality was observed. These findings support further prospective evaluation of GDMT optimization after LVAD implantation.