VAD therapy 20/20: moving beyond the myopic view of a nascent therapy

Longitudinal Heart Failure Medication Use and Adherence Following Left Ventricular Assist Device Implantation in Privately Insured Patients

BACKGROUND

There are few data describing the longitudinal use of and adherence to heart failure medications following left ventricular assist device (LVAD) implantation.

METHODS AND RESULTS

Using a large US commercial insurance database, patients who received an LVAD (International Classification of Diseases, 9th Revision, Clinical Modification code 37.66) and survived to hospital discharge without heart transplantation between January 1, 2006, and March 31, 2015, were identified. Heart failure medication use from 3 months before 1-year post-LVAD was examined using linked pharmacy claims. Differences in the proportion of patients taking heart failure medications post LVAD compared with pre LVAD were examined using McNemar test. Predictors of post-LVAD medication use and poor medication adherence (proportion of days covered <0.8) were identified via logistic regression. Among 362 patients (mean age, 57.4 years; 75.1% men), compared with pre LVAD, the proportion of patients taking anticoagulants and antiarrhythmics following LVAD increased; mineralocorticoid receptor antagonists, thiazide diuretics, and digoxin decreased; and β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and loop diuretics did not change. Pre-LVAD medication use was associated with post-LVAD use across all medication classes. The proportion of patients with poor medication adherence was 28.8%, 39.0%, and 36.0% for β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and anticoagulants, respectively. Many patients with poor adherence completely discontinued use of the medication.

CONCLUSIONS

Neurohormonal antagonist use after LVAD was inconsistent, perhaps reflecting uncertainty of therapeutic benefit in this population. Medication adherence post-LVAD was poor in many patients. Further work is needed to delineate the reasons for nonadherence after LVAD.