Association of ACEI/ARB and statin prescribing patterns with mortality after Transcatheter Aortic Valve Replacement (TAVR): Findings from real-world claims data - 14/03/23
, Shannon M.E. Murphy, MA b, Craig R. Asher, MD c, Santiago A. Garcia, MD d, Juan F. Granada, MD e, Creighton W. Don, MD f, g, Sankalp Patel, DO a, Mazen S. Albaghdadi, MD a, João L. Cavalcante, MD h, Megan Coylewright, MD i, Rebecca T. Hahn, MD j, Philippe Genereux, MD k, Pradeep K. Yadav, MD l, Vinod H. Thourani, MD l, Martin B. Leon, MD jRiassunto |
Background |
Transcatheter aortic valve replacement (TAVR) has become the standard of care for most patients with severe aortic stenosis (AS), but the impact of medical therapy prescribing patterns on post-TAVR patients has not been thoroughly investigated.
Methods |
We analyzed Optum claims data from 9,012 adults who received TAVR for AS (January 2014-December 2018). Pharmacy claims data were used to identify patients who filled ACEI/ARB and/or statin prescriptions during the study's 90-day landmark period post-TAVR. Kaplan-Meier and adjusted Cox Proportional Hazards models were used to evaluate the association of prescribing patterns with mortality during the 3-year follow-up period. Subgroup analyses were performed to examine the impact of 11 potential confounders on the observed associations.
Results |
A significantly lower adjusted 3-year mortality was observed for patients with post-TAVR prescription for ACEI/ARBs (hazard ratio [HR] = 0.82, 95% confidence interval [CI] 0.74-0.91, P = .0003) and statins (HR = 0.85, 95% CI 0.77-0.94, P = .0018) compared to patients who did not fill prescriptions for these medications post-TAVR. Subgroup analyses revealed that the survival benefit associated with ACEI/ARB prescription was not affected by any of the potential confounding variables, except preoperative ACEI/ARB prescription was associated with significantly lower risk of mortality vs postoperative prescription only. No other subgroup variables had significant interactions associated with survival benefits, including preoperative use of statins.
Conclusions |
In this large-scale, real-world analysis of patients undergoing TAVR, the prescription of ACEI/ARB and statins was associated with a significantly lower risk of mortality at 3-years, especially in those where the medications were initiated preoperatively.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Aortic stenosis, Transcatheter aortic valve replacement, Renin-angiotensin system inhibitor, ACEI/ARB, Statin
Mappa
Vol 258
P. 27-37 - Aprile 2023 Ritorno al numero
Articolo precedente
- Sex-stratified differences in early antithrombotic treatment response in patients presenting with ST-segment elevation myocardial infarction
- Ronak Delewi, Rosanne F. Vogel, Jeroen M. Wilschut, Miguel E. Lemmert, Roberto Diletti, Ria van Vliet, Nancy W.P.L. van der Waarden, Rutger-Jan Nuis, Valeria Paradies, Dimitrios Alexopoulos, Felix Zijlstra, Gilles Montalescot, Dominick J. Angiolillo, Mitchell W. Krucoff, Pieter A. Doevendans, Nicolas M. Van Mieghem, Pieter C. Smits, Georgios J. Vlachojannis
- Outcomes in patients with cardiometabolic disease who develop hyperkalemia while treated with a renin-angiotensin-aldosterone system inhibitor
- Matthew Johnson, Fritha J. Morrison, Gearoid McMahon, Maxwell Su, Alexander Turchin
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
L'accesso al testo integrale di questo articolo richiede un abbonamento.
Già abbonato a @@106933@@ rivista ?