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

Area of Science:

• Cardiology
• Pharmacology
• Congenital Heart Disease

Background:

• Patients with systemic right ventricle (SRV) often develop severe right ventricular dysfunction.
• The effectiveness of beta-blockers and angiotensin receptor blockers or angiotensin-converting enzyme inhibitors (ACEI) in SRV patients remains unproven.

Purpose of the Study:

• To evaluate the impact of ACEI/ARB and beta-blocker medications on outcomes in SRV patients.
• To account for potential confounding factors influencing medication use in SRV patients.

Main Methods:

• Retrospective, multicenter study of heart failure outcomes in SRV patients.
• Propensity score matching was used to compare patients on ACEI/ARB, beta-blockers, or both, with those not on these medications.
• Primary outcomes included death, transplant, or mechanical circulatory support; secondary outcomes were heart failure hospitalizations and atrial arrhythmias.

Main Results:

• 393 patients were on ACEI/ARB or beta-blockers; 484 were not.
• After propensity matching, medication use was not linked to reduced mortality, heart failure hospitalizations, or arrhythmias.
• Hazard ratios for beta-blockers were positive, suggesting potential harm.

Conclusions:

• Beta-blockers or ACEI/ARB did not demonstrate benefit in survival or reduced hospitalizations for SRV patients.
• The potential for favorable effects in larger studies appears unlikely.
• Current evidence does not support the use of these medications for improving outcomes in SRV.