Propensity Score Analysis of Possible Medication Effects on Outcomes in Patients With Systemic Right Ventricles

Year: 2024

Type: article

Abstract: 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.

Source: JACC Advances

DOI: 10.1016/j.jacadv.2024.101443

Institutions: Brigham and Women's Hospital, Boston Children's Hospital, Harvard University, University of Gothenburg, Ospedale Monaldi, Vanderbilt University Medical Center, Johns Hopkins University, Johns Hopkins Hospital, Erasmus MC, ERN GUARD-Heart, Children's National, The Royal Melbourne Hospital, Seattle Children's Hospital, University of Washington Medical Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Hospital Universitario Virgen del Rocío, Emory University Hospital, University of California, Los Angeles, Ronald Reagan UCLA Medical Center, UCLA Medical Center, Children's Hospital & Medical Center, University of Nebraska Medical Center, University Hospital in Motol, The University of Sydney, Royal Prince Alfred Hospital, Regina General Hospital, Amsterdam University Medical Centers, University of British Columbia, St. Paul's Hospital, Stanford Medicine, Stanford University, Children's Hospital of Wisconsin, Montreal Heart Institute, University of Mississippi Medical Center, University of Alberta, Auckland City Hospital, University Health Network, University of Toronto, Toronto General Hospital, Ochsner Medical Center, University of Michigan, Michigan Medicine, Saint Luke's Hospital, Oregon Health & Science University

Language: English

Topic: Congenital Heart Disease Studies

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,850

OpenAlex ID: W4405377841