RAS inhibitors and renal and general mortality in patients with heart failure supported by left ventricular assist devices: a registry study

Clin Res Cardiol. 2023 Jul;112(7):891-900. doi: 10.1007/s00392-022-02136-6. Epub 2022 Dec 2.

Abstract

Background: The aim of our study was to analyze the association between renin-angiotensin system inhibitor (RASi) therapy and renal outcomes and mortality in patients with heart failure (HF) supported by left ventricular assist device (LVAD) using a large, nationwide prospective cohort. To date, no studies have comprehensively analyzed the association between RASi and renal outcomes and mortality in patients with HF supported by LVAD.

Methods: We performed a retrospective observational study on LVAD patients in the Interagency Registry for Mechanically Assisted Circulatory Support. The main outcome was a composite of renal event and all-cause mortality. Secondary outcomes were the individual components of the composite outcome. A renal event was defined as a composite of doubling serum creatinine, eGFR decrease ≥ 40%, or need for dialysis. The exposure of interest was RASi therapy, updated during follow-up. Cox regression models adjusted for potential confounders were used to estimate the association between time-updated RASi therapy and the outcomes of interest.

Results: The analysis included 6448 patients. During a median follow-up of 12.7 months (IQR 19.8 months), 1632 patients developed the composite outcome. RASi therapy was associated with a lower risk of developing the composite outcome (HR 0.61, 95% CI 0.55, 0.68, P < 0.001). A significant association was confirmed between RASi therapy and renal outcomes (HR 0.74, 95% CI 0.61, 0.89, P = 0.002) and all-cause mortality (HR 0.56, 95% CI 0.50, 0.63, P < 0.001).

Conclusions: Our data suggest a beneficial role of RASi therapy on renal function and all-cause mortality in patients with HF supported by LVAD.

Keywords: All-cause mortality; Epidemiological study; LVAD patients; RASi therapy; Renal outcome.

Publication types

  • Observational Study

MeSH terms

  • Antineoplastic Agents*
  • Heart Failure*
  • Heart-Assist Devices* / adverse effects
  • Humans
  • Kidney / physiology
  • Prospective Studies
  • Registries
  • Treatment Outcome

Substances

  • Antineoplastic Agents