Medication in adults after atrial switch for transposition of the great arteries: clinical practice and recommendations
Woudstra, Odilia I; Kuijpers, Joey M; Jongbloed, Monique R M; van Dijk, Arie P J; Sieswerda, Gertjan Tj; Vliegen, Hubert W; Egorova, Anastasia D; Kiès, Philippine; Duijnhouwer, Anthonie L; Robbers-Visser, Daniëlle; Konings, Thelma C; Zwinderman, Aeilko H; Meijboom, Folkert J; Mulder, Barbara J M; Bouma, Berto J
(2022) European heart journal - Cardiovascular pharmacotherapy, volume 8, issue 1, pp. 77 - 84
(Article)
Abstract
AIMS: Heart failure is the main threat to long-term health in adults with transposition of the great arteries (TGA) corrected by an atrial switch operation (AtrSO). Current guidelines refrain from recommending heart failure medication in TGA-AtrSO, as there is insufficient data to support the hypothesis that it is beneficial. Medication
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is therefore prescribed based on personal judgements. We aimed to evaluate medication use in TGA-AtrSO patients and examine the association of use of renin-angiotensin-aldosterone system (RAAS) inhibitors and β-blockers with long-term survival. METHODS AND RESULTS: We identified 150 TGA-AtrSO patients [median age 30 years (interquartile range 25-35), 63% male] included in the CONCOR registry from five tertiary medical centres with subsequent linkage to the Dutch Dispensed Drug Register for the years 2006-2014. Use of RAAS inhibitors, β-blockers, and diuretics increased with age, from, respectively, 21% [95% confidence interval (CI) 14-40], 12% (95% CI 7-21), and 3% (95% CI 2-7) at age 25, to 49% (95% CI 38-60), 51% (95% CI 38-63), and 41% (95% CI 29-54) at age 45. Time-varying Cox marginal structural models that adjusted for confounding medication showed a lower mortality risk with use of RAAS inhibitors and β-blockers in symptomatic patients [hazard ratio (HR) = 0.13 (95% CI 0.03-0.73); P = 0.020 and HR = 0.12 (95% CI 0.02-0.17); P = 0.019, respectively]. However, in the overall cohort, no benefit of RAAS inhibitors and β-blockers was seen [HR = 0.93 (95% CI 0.24-3.63); P = 0.92 and HR = 0.98 (0.23-4.17); P = 0.98, respectively]. CONCLUSION: The use of heart failure medication is high in TGA-AtrSO patients, although evidence of its benefit is limited. This study showed lower risk of mortality with use of RAAS inhibitors and β-blockers in symptomatic patients only. These findings can direct future guidelines, supporting use of RAAS inhibitors and β-blockers in symptomatic, but not asymptomatic patients.
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Keywords: Adrenergic beta-Antagonists/adverse effects, Adult, Arteries, Dispensed drugs, Female, Heart Failure/diagnosis, Heart failure, Humans, Male, Middle Aged, Mustard, Renin-Angiotensin System, Senning, Transposition of Great Vessels/diagnosis, Transposition of the great arteries, Cardiology and Cardiovascular Medicine, Pharmacology (medical), Research Support, Non-U.S. Gov't, Journal Article
ISSN: 2055-6837
Publisher: Oxford University Press
Note: Funding Information: This work was supported by the Dutch Heart Foundation [CVON 2014- 18 project CONCOR-genes to F.J.M. and B.J.B.] and the Amsterdam University Fund [8532 to O.I.W.] Publisher Copyright: © 2020 The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.
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