Adham Elmously1, Andreas R de Biasi1, Donald A Risucci2,3, Berhane Worku1, Evelyn M Horn4, Arash Salemi1. 1. Department of Cardiothoracic Surgery, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY, USA. 2. Department of Surgery, New York Methodist Hospital, New York, NY, USA. 3. Department of Surgery, New York Medical College, Valhalla, NY, USA. 4. Department of Medicine, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY, USA.
Abstract
BACKGROUND: Elevated systemic blood pressure (SBP) has been linked to complications in Continuous-flow left ventricular assist devices (CF-LVADs), including stroke and pump thrombosis. We queried Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) to describe the response of SBP to CF-LVAD implantation and to delineate contemporary trends in antihypertensive (AH) utilization for patients with these pumps. METHODS: We identified all CF-LVAD implantations in patients older than 18 years from 2006-2014, excluding those whose durations were less than 30 days. Pre-implant patient demographics and characteristics were obtained for each record. SBPs [i.e., mean arterial pressures (MAPs)], AH-use data, and vital status were tabulated, extending up to 5 years following implantation. RESULTS: A total of 10,329 CF-LVAD implantations were included for study. Post-implant, SBPs increased rapidly during the first 3 months but plateaued thereafter; AH utilization mirrored this trend. By 6 months, mean MAPs climbed 12.2% from 77.6 mmHg (95% CI: 77.4-77.8) pre-implantation to 87.1 mmHg (95% CI: 86.7-87.4) and patients required a mean of 1.8 AH medications (95% CI: 1.75-1.78) -a 125% increase from AH use at 1-week post-implantation (0.8 AHs/patient, 95% CI: 0.81-0.83) but a 5.3% decrease from pre-implant utilization (1.9 AHs/patient, 95% CI: 1.90-1.92). Once medication changes stabilized, the most common AH regimens were lone beta blockade (15%, n=720) and a beta blocker plus an ACE inhibitor (14%, n=672). CONCLUSIONS: SBP rises rapidly after CF-LVAD implantation, stabilizing after 3 months, and is matched by concomitant changes in AH utilization; this AH use has increased over consecutive implant years.
BACKGROUND: Elevated systemic blood pressure (SBP) has been linked to complications in Continuous-flow left ventricular assist devices (CF-LVADs), including stroke and pump thrombosis. We queried Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) to describe the response of SBP to CF-LVAD implantation and to delineate contemporary trends in antihypertensive (AH) utilization for patients with these pumps. METHODS: We identified all CF-LVAD implantations in patients older than 18 years from 2006-2014, excluding those whose durations were less than 30 days. Pre-implant patient demographics and characteristics were obtained for each record. SBPs [i.e., mean arterial pressures (MAPs)], AH-use data, and vital status were tabulated, extending up to 5 years following implantation. RESULTS: A total of 10,329 CF-LVAD implantations were included for study. Post-implant, SBPs increased rapidly during the first 3 months but plateaued thereafter; AH utilization mirrored this trend. By 6 months, mean MAPs climbed 12.2% from 77.6 mmHg (95% CI: 77.4-77.8) pre-implantation to 87.1 mmHg (95% CI: 86.7-87.4) and patients required a mean of 1.8 AH medications (95% CI: 1.75-1.78) -a 125% increase from AH use at 1-week post-implantation (0.8 AHs/patient, 95% CI: 0.81-0.83) but a 5.3% decrease from pre-implant utilization (1.9 AHs/patient, 95% CI: 1.90-1.92). Once medication changes stabilized, the most common AH regimens were lone beta blockade (15%, n=720) and a beta blocker plus an ACE inhibitor (14%, n=672). CONCLUSIONS: SBP rises rapidly after CF-LVAD implantation, stabilizing after 3 months, and is matched by concomitant changes in AH utilization; this AH use has increased over consecutive implant years.
Entities:
Keywords:
Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS); Systemic blood pressure (SBP); antihypertensive (AH); continuous-flow (CF); left ventricular assist device (LVAD)
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