Miloud Cherbi

Background: While guideline-directed medical therapy (GDMT) is recommended for left ventricular assist device (LVAD) recipients, real-world evidence supporting its clinical impact remains limited. This study evaluated the association between GDMT prescription and clinical outcomes in LVAD patients. Methods: This international retrospective multicentre study included 875 LVAD patients from 22 centres. Patients were categorized based on the number of GDMT (ACE-I/ARBs, beta-blockers, MRAs) prescribed. Primary outcome was 6-month all-cause mortality. Secondary outcome was late ventricular arrhythmias (VAs) (>30 days post-implant). Multivariable Cox regression and ordinal logistic regression analyses were performed. Results: Overall, only 261 patients (29.8%) received triple GDMT, while 97 (11.1%) received no GDMT. After multivariable adjustment, the number of prescribed GDMTs was independently associated with improved survival, with aHRs for all-cause mortality of 0.51 (0.33–0.75, P < .01) for triple therapy, 0.39 (0.26–0.59, P < .01) for dual therapy, and 0.45 (0.30–0.67, P < .01) for single therapy, all compared with no GDMT. Similarly, ACE-I/ARB were associated with a lower risk of late VAs (aHR 0.65 [0.50–0.84], P < .01). Female sex, diabetes, early VAs, and higher bilirubin levels were associated with lower GDMT prescription rates. Major LVEDD improvement (≥10 mm reduction) increased progressively from 51.5% without GDMT to 66.1% with triple therapy. Conclusion: In this large international study, the use of GDMT in LVAD patients was associated with improved survival, with benefits observed even with single-agent therapy. Despite these benefits, only 30% of patients received optimal triple therapy, highlighting the need for improved implementation strategies and standardized protocols in this population.

Background While heart failure (HF) duration before left ventricular assist device (LVAD) implantation may influence postoperative outcomes, data evaluating this relationship remains limited. This study investigated the association between HF duration and outcomes following LVAD implantation. Methods This international retrospective multicenter study included 1,071 patients who underwent LVAD implantation between 2006—2019. Patients were stratified into quartiles by HF duration before implantation: Q1 ≤ 3.9 months, Q2 > 3.9 months-4 years, Q3 > 4—10.7 years, and Q4 ≥ 10.7 years. Primary outcome was 3-year all-cause mortality. Secondary outcomes included cardiac death, early (≤ 30 days) and late ventricular arrhythmias (VAs), and left ventricular ejection fraction (LVEF) recovery. Multivariable Cox regression and restricted cubic spline analyses were performed. Results After 3-year follow-up, 426 patients died (31.1% in Q1 vs 48.5% in Q4). Patients with longest HF duration (Q4) had higher mortality risk compared to Q1 (aHR 1.57 [1.18–2.09]) and cardiac death risk (aHR 1.69 [1.13—2.55]). Early VAs increased progressively with HF duration, with Q3 (aHR 1.74 [1.19—2.53]) and Q4 (aHR 1.79 [1.23—2.60]) showing significantly elevated risks. Late VAs demonstrated the most pronounced association (Q4 vs Q1: aHR 5.75 [3.46—9.26]). LVEF recovery decreased progressively, with major LVEF improvement (≥ 10%) occurring in 37% of Q1 versus 19.4% of Q4 patients. Conclusion Prolonged HF duration before LVAD implantation was associated with worse outcomes, emphasizing the importance of timely referral to specialized centers and optimized care pathways for advanced HF management. Graphical abstract BMI, body mass index; HF, heart failure; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction The alternative text for this image may have been generated using AI.