Clinical Impact of Guideline-Directed Medical Therapy in Patients with Left Ventricular Assist Device: An International Multicenter Study
Abstract
Background: While guideline-directed medical therapy (GDMT) is recommended for left ventricular assist device (LVAD) recipients, real-world evidence supporting its clinical impact remains limited. This study evaluated the association between GDMT prescription and clinical outcomes in LVAD patients. Methods: This international retrospective multicenter study included 875 LVAD patients from 22 centers. Patients were categorized based on the number of GDMT (ACE-I/ARBs, beta-blockers, MRAs) prescribed. Primary outcome was 6-month all-cause mortality. Secondary outcome was late ventricular arrhythmias (VAs) (>30 days post-implant). Multivariable Cox regression and ordinal logistic regression analyses were performed. Results: Overall, only 261 patients (29.8%) received triple GDMT, while 97 (11.1%) received no GDMT. After multivariable adjustment, the number of prescribed GDMTs was independently associated with improved survival, with aHRs for all-cause mortality of 0.51 (0.33-0.75, p<0.01) for triple therapy, 0.39 (0.26-0.59, p<0.01) for dual therapy, and 0.45 (0.30-0.67, p<0.01) for single therapy, all compared with no GDMT. Similarly, ACE-I/ARB were associated with a lower risk of late VAs (aHR 0.65 [0.50-0.84], p<0.01). Female sex, diabetes, early VAs, and higher bilirubin levels were associated with lower GDMT prescription rates. Major LVEDD improvement (≥10mm reduction) increased progressively from 51.5% without GDMT to 66.1% with triple therapy. Conclusion: In this large international study, the use of GDMT in LVAD patients was associated with improved survival, with benefits observed even with single-agent therapy. Despite these benefits, only 30% of patients received optimal triple therapy, highlighting the need for improved implementation strategies and standardized protocols in this population.
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BibTeX
@article{cherbi2026clinical,
title = {{Clinical Impact of Guideline-Directed Medical Therapy in Patients with Left Ventricular Assist Device: An International Multicenter Study}},
author = {Miloud Cherbi and Clément Delmas and Paul Gautier and Karim Benali and Kerstin Bode and Elena Efimova and Alexey Dashkevich and Jackson J. Liang and John Larson and Blandine Mondésert and Jacinthe Boulet and Pierre-Emmanuel Noly and François Picard and Jean-Luc Pasquié and Jean-Baptiste Gourraud and Sandro Ninni and Laurence Jesel-Morel and Alexandre Sebestyen and Marylou Para and Jean-Claude Deharo and Frédéric Anselme and Laure Champ-Rigot and Soundous M’rabet and Bertrand Pierre and Romain Eschalier and Mathieu Echivard and Anne-Céline Martin and Nicolas Lellouche and Matteo Pozzi and Pierre Groussin and Erwan Flécher and Vincent Galand and Raphaël P Martins},
journal = {ESC Heart Failure},
year = {2026},
month = jun,
doi = {10.1093/eschf/xvag174},
url = {https://hal.science/hal-05674207v1},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Clinical Impact of Guideline-Directed Medical Therapy in Patients with Left Ventricular Assist Device: An International Multicenter Study
AU - Miloud Cherbi
AU - Clément Delmas
AU - Paul Gautier
AU - Karim Benali
AU - Kerstin Bode
AU - Elena Efimova
AU - Alexey Dashkevich
AU - Jackson J. Liang
AU - John Larson
AU - Blandine Mondésert
AU - Jacinthe Boulet
AU - Pierre-Emmanuel Noly
AU - François Picard
AU - Jean-Luc Pasquié
AU - Jean-Baptiste Gourraud
AU - Sandro Ninni
AU - Laurence Jesel-Morel
AU - Alexandre Sebestyen
AU - Marylou Para
AU - Jean-Claude Deharo
AU - Frédéric Anselme
AU - Laure Champ-Rigot
AU - Soundous M’rabet
AU - Bertrand Pierre
AU - Romain Eschalier
AU - Mathieu Echivard
AU - Anne-Céline Martin
AU - Nicolas Lellouche
AU - Matteo Pozzi
AU - Pierre Groussin
AU - Erwan Flécher
AU - Vincent Galand
AU - Raphaël P Martins
PY - 2026
DA - 2026/06/22
JO - ESC Heart Failure
DO - 10.1093/eschf/xvag174
UR - https://hal.science/hal-05674207v1
AB - Background: While guideline-directed medical therapy (GDMT) is recommended for left ventricular assist device (LVAD) recipients, real-world evidence supporting its clinical impact remains limited. This study evaluated the association between GDMT prescription and clinical outcomes in LVAD patients. Methods: This international retrospective multicenter study included 875 LVAD patients from 22 centers. Patients were categorized based on the number of GDMT (ACE-I/ARBs, beta-blockers, MRAs) prescribed. Primary outcome was 6-month all-cause mortality. Secondary outcome was late ventricular arrhythmias (VAs) (>30 days post-implant). Multivariable Cox regression and ordinal logistic regression analyses were performed. Results: Overall, only 261 patients (29.8%) received triple GDMT, while 97 (11.1%) received no GDMT. After multivariable adjustment, the number of prescribed GDMTs was independently associated with improved survival, with aHRs for all-cause mortality of 0.51 (0.33-0.75, p<0.01) for triple therapy, 0.39 (0.26-0.59, p<0.01) for dual therapy, and 0.45 (0.30-0.67, p<0.01) for single therapy, all compared with no GDMT. Similarly, ACE-I/ARB were associated with a lower risk of late VAs (aHR 0.65 [0.50-0.84], p<0.01). Female sex, diabetes, early VAs, and higher bilirubin levels were associated with lower GDMT prescription rates. Major LVEDD improvement (≥10mm reduction) increased progressively from 51.5% without GDMT to 66.1% with triple therapy. Conclusion: In this large international study, the use of GDMT in LVAD patients was associated with improved survival, with benefits observed even with single-agent therapy. Despite these benefits, only 30% of patients received optimal triple therapy, highlighting the need for improved implementation strategies and standardized protocols in this population.
SN - 2055-5822
ER -