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Propensity Score Analysis of Possible Medication Effects on Outcomes in Patients With Systemic Right Ventricles
A. Misra, CP. Rodriguez-Monserrate, K. Gauvreau, M. Dellborg, F. Fusco, T. Gupta, J. Kay, S. Kutty, RM. Kauling, J. Nicolarsen, J. Roos-Hesselink, AS. John, J. Wong, LJ. Burchill, EV. Krieger, AM. Lubert, P. Gallego, M. Kuo, J. Aboulhosn, J....
Status not-indexed Language English Country United States
Document type Journal Article
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Directory of Open Access Journals
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PubMed Central
from 2022
ROAD: Directory of Open Access Scholarly Resources
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- Publication type
- Journal Article MeSH
BACKGROUND: Patients with systemic right ventricle (SRV), either d-transposition of the great arteries following an atrial switch procedure or congenitally corrected transposition of the great arteries, develop severe right ventricular dysfunction, prompting appropriate medical therapy. However, the efficacy of beta-blockers and angiotensin receptor blockers or angiotensin-converting enzyme inhibitors (ACEI) in SRV patients is unproven. OBJECTIVES: The objective of this study was to determine the effects of ACEI/ARB and beta-blockers on outcomes in SRV patients after accounting for likely cofounders affecting their use. METHODS: From a retrospective, multicenter study on heart failure-related outcome in individuals with SRV, those who were taking an ACEI/ARB, beta-blocker, or both of these medication were identified. We performed a propensity analysis to match them to those not using these medications at their initial visit. Matching was based on a propensity score, which captured co-morbidities, demographics, and baseline echocardiographic parameters. Primary outcome of death, transplant, or mechanical circulatory support, and secondary outcomes of heart failure hospitalizations/atrial arrhythmias were analyzed respectively. RESULTS: We identified 393 patients taking ACEI/ARB or beta-blocker, or taking both a beta-blocker and ACEI/ARB (62.1% male, median age 31.3 years) and 484 patients (56.4% male, median age of 26.0 years) who were neither on a beta-blocker nor on ACEI/ARB at the time of initial clinic visit. Median follow-up was ∼8 years. After propensity matching, medication use was not associated with decreased mortality, heart failure hospitalizations, or arrhythmias. Hazard ratios remained positive for beta blockers, implying potential harm rather than benefit. CONCLUSIONS: In this large multicenter propensity-matched observational study, patients with SRV taking beta-blockers or ACEI/ARB did not have a benefit in survival or reduced hospitalization. The likelihood of demonstrating favorable effects in larger studies appears remote.
Adult Congenital Heart Disease Unit Hospital Universitario Virgen Del Rocio Sevilla Spain
Adult Congenital Heart Disease Unit Monaldi Hospital Napoli Italy
Boston Children's Hospital Harvard Medical School Boston Massachusetts USA
Children's Hospital Omaha and University of Nebraska Medical Center Omaha Nebraska USA
Department of Cardiology Erasmus Medical Center Rotterdam the Netherlands
Department of Cardiology Regina General Hospital Regina Saskatchewan Canada
Department of Cardiology University of Mississippi Medical Center Jackson Mississippi USA
Department of Cardiology University of Sydney and Royal Prince Alfred Hospital Sydney Australia
Department of Medicine Montreal Heart Institute Montreal Heart Institute Montreal Quebec Canada
Department of Medicine Royal Melbourne Hospital Melbourne Australia
Division of Cardiology Amsterdam University Medical Center Amsterdam the Netherlands
Division of Cardiology Children's Hospital of Wisconsin Milwaukee Wisconsin USA
Division of Cardiology Department of Medicine Emory University Hospital Atlanta Georgia USA
Division of Cardiology Krannert Institute of Cardiology Indianapolis Indiana USA
Division of Cardiology Saint Luke's Mid America Heart Institute Hospital Kansas City Missouri USA
Division of Cardiology University of Michigan Medical Center Ann Arbor Michigan USA
Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville Tennessee USA
Division of Pediatric Cardiology Children's National Hospital Washington DC USA
Green Lane Paediatric and Congenital Cardiac Service Auckland City Hospital Auckland New Zealand
Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
Internal Medicine Cardiology University of Alberta Edmonton Alberta Canada
Knight Cardiovascular Institute Oregon Health and Science University Portland Oregon USA
Ochsner Medical Center New Orleans Los Angeles USA
Providence Adult and Teen Congenital Heart Program Providence Spokane Spokane Washington USA
University of Washington Medical Center and Seattle Children's Hospital Seattle Washington USA
References provided by Crossref.org
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