Association of ACEI/ARB and statin prescribing patterns with mortality after Transcatheter Aortic Valve Replacement (TAVR): Findings from real-world claims data.

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.
Competing Interests: Conflict of interest Dr. Cubeddu reports receiving payments for occasional lectures from Edwards Lifesciences. Ms. Murphy reports current employment at Edwards Lifesciences; and being a stockholder at Edwards Lifesciences. Dr. Asher reports receiving royalties for educational Books from Wolters Kluwer Publishing Company. Dr. Garcia is supported by The Harold C. Schott Foundation Endowed Chair for Structural and Valvular Heart Disease and is proctor and steering committee member for Edwards Lifesciences. Dr. Granada has no disclosures to report. Dr. Don reports current participation on the data safety monitoring board (DSMB) of Statins for rheumatic heart disease-Nepal. Dr. Patel has no disclosures to report. Dr. Albaghdadi has no disclosures to report. Dr. Cavalcante reports receiving consulting fees from Abbott Structural, Aria CV, Boston Scientific, Edwards Lifesciences, Medtronic, Vdyne, W.L. Gore, and Xylocor. Dr. Coylewright reports receiving fees or honoraria for lectures, presentations, speakers bureau, manuscript writing or educational events from Medtronic, Abbott, Occlutech, CardioSmart, Edwards Lifesciences, and Boston Scientific. Dr. Hahn reports speaker fees from Abbott Structural, Baylis Medical, Edwards Lifesciences, and Philips Healthcare; she has institutional consulting contracts for which she receives no direct compensation with Abbott Structural, Edwards Lifesciences, Medtronic and Novartis; she is Chief Scientific Officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored tricuspid valve trials, for which she receives no direct industry compensation. Dr. Genereux reports receiving consultation fees and institution research grant from Edwards Lifesciences; and receiving payment or honoraria for lectures from Edwards Lifesciences. Dr. Yadav reports receiving consulting fees from Edwards Lifesciences and Abbott Vascular; receiving payment or honoraria for lectures, presentations, speakers bureau, manuscript writing or educational events from Edwards Lifesciences, Abbott Vascular, and Shockwave medical; and current participation on the DSMB or advisory board of Dasi simulations. Dr Thourani reports receiving grants from Edwards Lifesciences; and receiving payment or honoraria for lectures, presentations, speakers bureau, manuscript writing or educational events from Edwards Lifesciences. Dr. Leon reports receiving grants or contracts from Abbott Vascular, Medtronic, Boston Scientific, and Edwards Lifesciences; and receiving consulting fees from Bain Capital.
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