Date: Sunday, June 2, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Blood pressure (BP) control, aspirin, and statin use are modifiable risk factors for primary prevention of atherosclerotic cardiovascular disease (ASCVD), stroke, and heart failure (HF), which are major complications in liver transplant recipients (LTRs). Adherence to guidelines for primary prevention of these conditions by transplant providers and the impact of adherence on CV events among LTRs are unclear.
*Methods: An inception cohort in an urban, tertiary care facility between 2010-2016, of 602 LTRs, age 18-79 years, who survived to hospital discharge, were defined using electronic health record data. HF risk was defined as having diabetes, hypertension, chronic kidney disease, age >75 years, NASH, or a Framingham Risk Score > 15%. LTRs with diabetes or ASCVD risk score >10% were considered high risk for ASCVD or stroke. Using time-dependent Cox models adjusted for age and sex, we compared CV events between at risk LTRs who received guideline-directed care and those who did not.
*Results: Among the 602 LTRs (mean age 56.7 years, 64% male, 61% non-Hispanic white), prevalence of ASCVD was 60%, stroke was 19%, and was HF 17% 1-year post-LT and increased to 68%, 30% and 26% by 6-years post-LT, respectively. In LTRs at high risk for ASCVD/stroke, only 17% received a statin and 29% aspirin, post-LT. In LTRs at risk for HF, 41% had guideline-recommended average BP <130/80 mmHg 1-year post-LT, which decreased to 27% by 6-years post-LT. BP <130/80 mmHg was not associated with decreased HF events (adjusted hazard ratio aHR):1.07, 95% confidence interval (CI):0.66-1.72). Similarly, neither statin (aHR: 0.65, 95% CI: 0.08-5.0) nor aspirin (aHR: 0.89, 95% CI:0.27-3.0) use was associated with decreased CV events.
*Conclusions: Transplant provider adherence to guidelines for primary prevention of CVD in LTRs is low and decreases over time, despite increasing CVD burden after LT. No statistical benefit was detected for guideline-adherence to primary prevention of ASCVD, stroke, or HF on CV events in LTRs. Prospective studies with increased power to detect meaningful clinical differences in CV event rates and mortality are needed in order to understand the potential role of quality improvement initiatives to improve transplant provider adherence to the guidelines.
To cite this abstract in AMA style:Kosirog M, Campbell PT, Montag S, Connolly S, Daud A, Das A, Pine S, Finn D, Levitsky J, Holl JL, Lloyd-Jones DM, VanWagner LB. Transplant Provider Adherence to Cardiovascular Disease Primary Prevention Guidelines in Liver Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/transplant-provider-adherence-to-cardiovascular-disease-primary-prevention-guidelines-in-liver-transplant-recipients/. Accessed January 26, 2020.
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