Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
J Am Heart Assoc. 2017 Oct 3;6(10):e005776. doi: 10.1161/JAHA.117.005776.
There are few data describing the longitudinal use of and adherence to heart failure medications following left ventricular assist device (LVAD) implantation.
Using a large US commercial insurance database, patients who received an LVAD ( code 37.66) and survived to hospital discharge without heart transplantation between January 1, 2006, and March 31, 2015, were identified. Heart failure medication use from 3 months before 1-year post-LVAD was examined using linked pharmacy claims. Differences in the proportion of patients taking heart failure medications post LVAD compared with pre LVAD were examined using McNemar test. Predictors of post-LVAD medication use and poor medication adherence (proportion of days covered <0.8) were identified via logistic regression. Among 362 patients (mean age, 57.4 years; 75.1% men), compared with pre LVAD, the proportion of patients taking anticoagulants and antiarrhythmics following LVAD increased; mineralocorticoid receptor antagonists, thiazide diuretics, and digoxin decreased; and β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and loop diuretics did not change. Pre-LVAD medication use was associated with post-LVAD use across all medication classes. The proportion of patients with poor medication adherence was 28.8%, 39.0%, and 36.0% for β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and anticoagulants, respectively. Many patients with poor adherence completely discontinued use of the medication.
Neurohormonal antagonist use after LVAD was inconsistent, perhaps reflecting uncertainty of therapeutic benefit in this population. Medication adherence post-LVAD was poor in many patients. Further work is needed to delineate the reasons for nonadherence after LVAD.
目前鲜有数据描述左心室辅助装置（LVAD）植入后心力衰竭药物的长期使用和依从性。
利用美国一个大型商业保险数据库，确定了 2006 年 1 月 1 日至 2015 年 3 月 31 日期间接受 LVAD（编码 37.66）治疗且在出院时未进行心脏移植的存活患者。使用链接的药房理赔数据检查 LVAD 前 3 个月至 LVAD 后 1 年的心力衰竭药物使用情况。使用 McNemar 检验比较 LVAD 后和 LVAD 前患者服用心力衰竭药物的比例差异。通过逻辑回归确定 LVAD 后药物使用和药物依从性差（覆盖率<0.8 的天数比例）的预测因素。在 362 例患者（平均年龄 57.4 岁，75.1%为男性）中，与 LVAD 前相比，LVAD 后服用抗凝剂和抗心律失常药物的患者比例增加；而使用盐皮质激素受体拮抗剂、噻嗪类利尿剂和地高辛的患者比例下降；β受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和袢利尿剂的使用未发生改变。LVAD 前药物使用与所有药物类别后 LVAD 的使用相关。药物依从性差的患者比例β受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和抗凝剂分别为 28.8%、39.0%和 36.0%。许多药物依从性差的患者完全停止使用药物。
LVAD 后神经激素拮抗剂的使用并不一致，这可能反映了该人群治疗获益的不确定性。许多 LVAD 后患者的药物依从性较差。需要进一步研究以明确 LVAD 后不依从的原因。
