Prophylactic drug treatment may increase risk of heart failure in patients who get heart device implants
Patients with left-sided heart failure who receive implants to improve the pumping of their hearts may be at increased risk of developing right-sided heart failure, if they receive prophylactic administration of selective vasodilatory drugs.
New research suggests that patients with heart failure on the left sides of their hearts, who receive surgical implants to aid heart pumping, are more likely to develop heart failure on the right side of their hearts if they also received selective vasodilatory drugs prior to implantation.
Up to 40% of patients who receive left-ventricular assist device (LVAD) surgery, for left-sided heart failure, go on to develop right-sided heart failure.
In pre-emption of surgery, physicians sometimes prescribe off-label, vasodilatory drugs, such as phosphodiesterase-5 inhibitors.
In this new study, researchers have analyzed 11,544 patients who received their LVAD implants between 2012 and 2017. 1199 of these individuals — equivalent to 10% of the study cohort — also received pre-implantation phosphodiesterase-5 drug treatment.
24% of all 11,544 patients assessed in this study developed right-sided heart failure. Individuals pretreated with phosphodiesterase-5 inhibitors developed right-sided heart failure at increased rates.
Further, researchers matched 1177 patients who received phosphodiesterase-5 drugs as LVAD surgery pretreatment with 1177 patients who did not receive this drug therapy. The patients were otherwise matched in terms of disease severity, age and concurrent presentation of other diseases that may have affected health outcome.
Patients who received drug therapy prior to implantation were 31% more likely to develop right-sided heart failure.
Additionally, bleeding risk within a week of LVAD surgery was 46% higher in patients receiving drug therapy, compared to patients not receiving phosphodiesterase-5 inhibitors.
Michael Kiernan, study senior investigator, cardiologist at the Tufts Medical Center and assistant professor of medicine at Tufts University School of Medicine in Boston, (MA, USA), commented that this study, the largest analysis to date to assess the benefit of preventative phosphodiesterase-5 inhibitor prescription alongside LVAD implantation, found “…no benefit of this therapy in patients receiving LVAD devices, including patients with pulmonary vascular disease or right ventricular dysfunction — the very patients who might be expected to benefit most.”
Kiernan concluded that the findings: “…should give pause to clinicians considering this therapy, and we would caution against routine use of these therapies prior to LVAD surgery.”