Impact of HF pharmacological therapy on the durability of favorable response after LVAD weaning: a VAD wean registry analysis

Background A subset of chronic HF patients can experience significant cardiac structural and functional improvement while on LVAD support. Purpose This study aimed to evaluate the impact of HF guideline-directed medical therapy (GDMT) on long-term outcomes following LVAD weaning. Methods We analyzed data from 407 HF patients enrolled in the international, multicenter VAD Wean Registry who received a durable continuous-flow LVAD and underwent device support weaning. Indications for VAD weaning included: structural/functional cardiac improvement meeting institutional criteria for "myocardial recovery" (responders) or LVAD-related complications accompanied by variable degrees of cardiac improvement (partial responders). The primary outcome was 5-year survival free from transplant or LVAD re-implantation. We investigated the association between post-LVAD weaning use of the following HF medications and the primary outcome: i) beta-blockers, ii) angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) or angiotensin receptor neprilysin inhibitors (ARNIs), and iii) mineralocorticoid antagonists (MRAs). Results In this cohort, 90% (n=368) of patients were treated with beta-blockers, 84% (n=341) with ACEi/ARBs/ARNIs, and 64% (n=260) with MRAs following LVAD weaning. Treatment with beta-blockers and ACEi/ARBs/ARNIs was significantly associated with better 5-year survival free from transplant or LVAD re-implantation (Figure 1A-B). These associations remained statistically significant even after adjusting for age at LVAD weaning, sex, and the reason for weaning (Table). No significant association was observed between MRA use and the primary outcome. Conclusions Treatment with beta-blockers and ACEi/ARBs/ARNIs post-LVAD weaning is associated with better 5-year outcomes. This study underscores the importance of GDMT utilization after mechanical support withdrawal to maintain favorable long-term outcomes.Figure 1A-B Table