TY - JOUR
T1 - Propensity Score Analysis of Possible Medication Effects on Outcomes in Patients With Systemic Right Ventricles
AU - Misra, Amrit
AU - Rodriguez-Monserrate, Carla P.
AU - Gauvreau, Kimberlee
AU - Dellborg, Mikael
AU - Fusco, Flavia
AU - Gupta, Tripti
AU - Kay, Joseph
AU - Kutty, Shelby
AU - Kauling, Robert M.
AU - Nicolarsen, Jeremy
AU - Roos-Hesselink, Jolien
AU - John, Anitha S.
AU - Wong, Joshua
AU - Burchill, Luke J.
AU - Krieger, Eric V.
AU - Lubert, Adam M.
AU - Gallego, Pastora
AU - Kuo, Marissa
AU - Aboulhosn, Jamil
AU - Cramer, Jonathan
AU - Antonova, Petra
AU - Baker, David
AU - Dehghani, Payam
AU - Opotowsky, Alexander R.
AU - van Dissel, Alexandra
AU - Grewal, Jasmine
AU - Yeung, Elizabeth
AU - Fernandes, Susan
AU - Ginde, Salil
AU - Khairy, Paul
AU - Han, Frank
AU - Muhll, Isabelle Vonder
AU - Wilson, William M.
AU - Kay, William Aaron
AU - Pylypchuk, Stephen
AU - Sarubbi, Berardo
AU - O'Donnell, Clare
AU - Rodriguez, Fred
AU - Jayadeva, Pavithra S.
AU - Celermajer, David S.
AU - Shah, Sangeeta
AU - Cotts, Timothy
AU - DeZorzi, Christopher
AU - Magalski, Anthony
AU - Valente, Anne Marie
AU - Broberg, Craig S.
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2025/1/1
Y1 - 2025/1/1
N2 - 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.
AB - 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.
KW - congenital heart diseas
KW - congestive heart failure
KW - systemic right ventricle
KW - transposition of the great arteries
UR - https://www.scopus.com/pages/publications/85211579583
U2 - 10.1016/j.jacadv.2024.101443
DO - 10.1016/j.jacadv.2024.101443
M3 - Article
C2 - 39759434
SN - 2772-963X
VL - 4
JO - JACC: Advances
JF - JACC: Advances
IS - 1
M1 - 101443
ER -