دانلود رایگان مقاله داروهای نارسایی قلبی برای بیماران دستگاه های کمکی بطن چپ

Background Real-world use of traditional heart failure (HF) medications for patients with left ventricular assist devices (LVADs) is not well known. Methods We conducted a retrospective, observational analysis of 1,887 advanced HF patients with and without LVADs from 32 LVAD hospitals participating in the Get With The Guidelines–Heart Failure registry from January 2009 to March 2015. We examined HF medication prescription at discharge, temporal trends, and predictors of prescription among patients with an in-hospital (n = 258) or prior (n = 171) LVAD implant, and those with advanced HF but no LVAD, as defined by a left ventricular ejection fraction ≤25% and in-hospital receipt of intravenous inotropes or vasopressin receptor antagonists (n = 1,458). Results For β-blocker and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB), discharge prescriptions were 58.9% and 53.5% for new LVAD patients, 53.8% and 42.9% for prior LVAD patients, and 73.4% and 63.2% for patients without LVAD support, respectively (both P b .0001). Aldosterone antagonist prescription quadrupled among LVAD patients during the study period (P b .0001), whereas ACEI/ARB use decreased nearly 20 percentage points (60.0% to 41.4%, P = .0003). In the multivariable analysis of LVAD patients, patient age was inversely associated with β-blocker, ACEI/ARB, and aldosterone antagonist prescription. Conclusions Traditional HF therapies were moderately prescribed at discharge to patients with LVADs and were more frequently prescribed to patients with advanced HF without LVAD support. Moderate prescription rates suggest clinical uncertainty in the use of antiadrenergic medication in this population. Further research is needed on the optimal medical regimen for patients with LVADs. (Am Heart J 2016;179:99-106.)

Conclusion

In summary, our multicenter registry analysis highlights the clinical uncertainty that surrounds prescription of β-blockers, ACEI/ARB, and aldosterone antagonists in LVAD recipients. Prescription of these antiadrenergic medications was highly variable between 2009 and 2015. They were not prescribed as frequently for LVAD recipients as they were for advanced HF patients without LVAD support. We hypothesize that the moderate use of HF medications in LVAD patients was due to medication intolerance and the lack of evidence to support their use. Further research is needed on the benefit of antiadrenergic therapy in patients with LVADs.