Heart failure & cardiomyopathiesCohort study
Clinical impact of guideline-directed medical therapy in patients with left ventricular assist device: an international multicentre study
- international retrospective multicentre study
Authors' 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.
Study context
- Population
- Left ventricular assist device (LVAD) patientsfrom 22 centres
- Participants
- 875 patients
- Exposure
- number of guideline-directed medical therapy (GDMT) prescribed
- triple therapyn = 261
- no GDMTn = 97reference
- Outcome
- all-cause mortality
- Follow-up
- 6-month
Main finding
As reported in the abstract
Each group vs no GDMTAdjusted hazard ratio (CI)P value
triple therapy
0.51(0.33–0.75)
P < 0.01dual therapy
0.39(0.26–0.59)
P < 0.01single therapy
0.45(0.30–0.67)
P < 0.01Observational data: associations, not effects.
Secondary outcomes
| Outcome | aHR (CI) | P value | |
|---|---|---|---|
| late ventricular arrhythmias (VAs) (>30 days post-implant) · lower risk of late VAs · Secondary outcome | 0.65 (0.50–0.84) | P < 0.01 | |
| 0.512Adjusted hazard ratio (log scale) |
| Outcome | triple therapy | dual therapy | single therapy | no GDMT | Estimate | P value |
|---|---|---|---|---|---|---|
| GDMT prescription | 29.8% | Not reported in the abstract | Not reported in the abstract | 11.1% | ||
| Major LVEDD improvement (≥10 mm reduction) · increased progressively | 66.1% | Not reported in the abstract | Not reported in the abstract | 51.5% |
Factors associated with lower GDMT prescription rates
- Female sex, diabetes, early ventricular arrhythmias (VAs), and higher bilirubin levels were associated with lower GDMT prescription rates
Original publication
Clinical impact of guideline-directed medical therapy in patients with left ventricular assist device: an international multicentre study. ESC Heart Fail. Published 22 June 2026. doi:10.1093/eschf/xvag174
Summarised from the published abstract; every number is checked against it