Guideline-Directed Heart Failure Therapy in Patients after Left Ventricular Assist Device Implantation: A Review

Abstract

Background: Left ventricular assist devices (LVADs) are used as an advanced therapy option for patients with stage D heart failure. These devices provide mechanical unloading of the heart as either a bridge to transplant or recovery, or as destination therapy. In patients with LVADs, there are emerging data on the use of heart failure guideline-directed medical therapy (GDMT) to improve outcomes. This review describes the current evidence available for the use of neurohormonal blocking agents in patients with LVADs. Methods: Articles were found using PubMed and web searches for heart failure therapies/neurohormonal blockade and LVADs. Studies were included if they evaluated the use of the heart failure therapies, either retrospectively or prospectively. Results: A total of 17 articles and 9 abstracts were reviewed. The totality of data surrounding the use of GDMT neurohormonal blockade in patients with LVADs are limited in nature. Much of the data are limited either by use of surrogate outcomes, single center evaluations, and/or small sample sizes. However, the evidence does support clinical benefit with associated mechanistic plausibility. More research is needed to understand appropriate patient selection and means to optimize these therapies in the LVAD population. Conclusion: Combined neurohormonal blockade appears to reduce morbidity and mortality in patients with LVAD implants.