Calcium Channel Blockers and Clinical Outcomes in Patients with Continuous-Flow Left Ventricular Assist Devices

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: End-stage heart failure requiring left ventricular assist device (LVAD) (n=10717). Intervention: Calcium channel blockers (CCBs) vs. No CCB treatment. Primary outcome: Long-term mortality (assessed as 5-year survival rate) from 6 months to 5 years after LVAD implantation (HR 1.03, 95% CI 0.91-1.17, p=0.624).

Q: What does this research mean for the field?

Calcium channel blocker therapy in patients with continuous-flow left ventricular assist devices is not associated with improved long-term survival and is linked to higher rates of adverse events including neurological dysfunction, bleeding, and renal dysfunction. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Hongtao Tie; Zhenhan Li; Henryk A. Welp; Avirup Guha; César Caraballo; Heinz Deschka; Rui Shi; Xiaoqing Zheng; Sven Martens; Sven Martens; Jürgen Sindermann; Dan Chen; Qingchen Wu

doi:10.1002/ehf2.14576

November 15, 2023ESC Heart FailureOpen Access

Calcium Channel Blockers and Clinical Outcomes in Patients with Continuous-Flow Left Ventricular Assist Devices

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Key result

Calcium channel blockers show no mortality benefit in LVAD patients and link to more adverse events.

HR 1.03
95% CI 0.91-1.17
P=0.624
n=10,717

Why the study?

The clinical outcomes of patients with continuous-flow LVAD who receive calcium channel blockers for blood pressure management remain unclear.

Does calcium channel blocker therapy reduce long-term mortality in adult patients with continuous-flow left ventricular assist devices?

Study Design

Type

Cohort (n=10,717)

Multicenter

Yes

Structured PICO

Does calcium channel blocker therapy reduce long-term mortality in adult patients with continuous-flow left ventricular assist devices?

P

Population

10,717 adult patients alive with a continuous-flow left ventricular assist device 6 months after implantation, followed for up to 5 years to assess the impact of calcium channel blockers.

E

Exposure

Calcium channel blocker (CCB) therapy received at 6 months after LVAD implantation (analyzed as both a time-constant and time-varying variable).

C

Comparator

No calcium channel blocker (CCB) therapy at 6 months after LVAD implantation.

O

Outcome

Long-term mortality from 6 months to 5 years after LVAD implantation.hard clinical

Main Result

Hazard Ratio: 1.03 (95% CI 0.91–1.17)

Absolute Event Rate: 49.6% vs 51.1%

p-value: p=0.624

Limitations

Retrospective observational design using registry data may contain unmeasured confounding variables.
The dosage, compliance, and clinical reasons for initiation or discontinuation of CCBs were unclear and unexplored.
The specific type/class of CCB (e.g., dihydropyridine vs non-dihydropyridine) was not available in the INTERMACS registry.
Device types varied significantly from 2006 to 2017, which may not fully represent contemporary outcomes with newer LVADs.
Retrospective registry study design inherently susceptible to residual and unmeasured confounding.
Dosage, compliance, and specific indications for initiation or discontinuation of CCBs remained unclear and unexplored.
The specific type and generation of CCB was unclear in the INTERMACS registry.
The analyzed LVAD devices varied from 2006 to 2017 and may not accurately represent the contemporary population with newer LVAD support.

Discussion

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Figures from the paper

Published by ESC Heart Failure · CC BY-NC-ND

Cite This Study

Tie et al. (2023) conducted a cohort in End-stage heart failure requiring left ventricular assist device (LVAD) (n=10,717). Calcium channel blockers (CCBs) vs. No CCB treatment was evaluated on Long-term mortality (assessed as 5-year survival rate) from 6 months to 5 years after LVAD implantation (HR 1.03, 95% CI 0.91-1.17, p=0.624). In patients with a left ventricular assist device, calcium channel blocker therapy was not associated with improved long-term mortality (HR 1.03) and was linked to increased risks of adverse events.

synapsesocial.com/papers/6ac5b0737dee5f26341d424c https://doi.org/10.1002/ehf2.14576

Topics

Mechanical circulatory support

Heart failure

HFrEF treatment

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Calcium Channel Blockers and Clinical Outcomes in Patients with Continuous-Flow Left Ventricular Assist Devices

Study Design

Structured PICO

Main Result

Limitations

Discussion

Figures from the paper

Cite This Study

Topics

Calcium Channel Blockers and Clinical Outcomes in Patients with Continuous-Flow Left Ventricular Assist Devices

Study Design

Structured PICO

Main Result

Limitations

Discussion

Figures from the paper

Cite This Study

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Topics

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