{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T10:25:52Z","timestamp":1783592752772,"version":"3.55.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>While guideline-directed medical therapy (GDMT) is recommended for left ventricular assist device (LVAD) recipients, real-world evidence supporting its clinical impact remains limited. This study evaluated the association between GDMT prescription and clinical outcomes in LVAD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This international retrospective multicentre study included 875 LVAD patients from 22 centres. Patients were categorized based on the number of GDMT (ACE-I\/ARBs, beta-blockers, MRAs) prescribed. Primary outcome was 6-month all-cause mortality. Secondary outcome was late ventricular arrhythmias (VAs) (&amp;gt;30 days post-implant). Multivariable Cox regression and ordinal logistic regression analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, only 261 patients (29.8%) received triple GDMT, while 97 (11.1%) received no GDMT. After multivariable adjustment, the number of prescribed GDMTs was independently associated with improved survival, with aHRs for all-cause mortality of 0.51 (0.33\u20130.75, P &amp;lt; .01) for triple therapy, 0.39 (0.26\u20130.59, P &amp;lt; .01) for dual therapy, and 0.45 (0.30\u20130.67, P &amp;lt; .01) for single therapy, all compared with no GDMT. Similarly, ACE-I\/ARB were associated with a lower risk of late VAs (aHR 0.65 [0.50\u20130.84], P &amp;lt; .01). Female sex, diabetes, early VAs, and higher bilirubin levels were associated with lower GDMT prescription rates. Major LVEDD improvement (\u226510\u2005mm reduction) increased progressively from 51.5% without GDMT to 66.1% with triple therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large international study, the use of GDMT in LVAD patients was associated with improved survival, with benefits observed even with single-agent therapy. Despite these benefits, only 30% of patients received optimal triple therapy, highlighting the need for improved implementation strategies and standardized protocols in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvag174","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T11:45:10Z","timestamp":1781783110000},"source":"Crossref","is-referenced-by-count":0,"title":["Clinical impact of guideline-directed medical therapy in patients with left ventricular assist device: an international multicentre study"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8952-6283","authenticated-orcid":false,"given":"Miloud","family":"Cherbi","sequence":"first","affiliation":[{"name":"Department of Cardiology, AZ Sint-Jan Hospital , Ruddershove 10, 8000 Bruges ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9180-9128","authenticated-orcid":false,"given":"Cl\u00e9ment","family":"Delmas","sequence":"additional","affiliation":[{"name":"Cardiology Department, Toulouse University Hospital , Toulouse ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9934-8432","authenticated-orcid":false,"given":"Paul","family":"Gautier","sequence":"additional","affiliation":[{"name":"Cardiology Department, Toulouse University Hospital , Toulouse ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7108-3427","authenticated-orcid":false,"given":"Karim","family":"Benali","sequence":"additional","affiliation":[{"name":"CHU Saint-Etienne, Universit\u00e9 Jean Monnet, Mines Saint-\u00c9tienne, Inserm U1059, SAINBIOSE Cardiology Department, , Saint-\u00c9tienne ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Bode","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Heart Center Leipzig , Leipzig ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2851-8931","authenticated-orcid":false,"given":"Elena","family":"Efimova","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology, Heart Center Leipzig , Leipzig ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6166-7210","authenticated-orcid":false,"given":"Alexey","family":"Dashkevich","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Heart Center Leipzig , Leipzig ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8608-8899","authenticated-orcid":false,"given":"Jackson","family":"Liang","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Michigan , Ann Arbor, MI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0257-5994","authenticated-orcid":false,"given":"John","family":"Larson","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Disease, Emory University , Atlanta, GA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7777-5689","authenticated-orcid":false,"given":"Blandine","family":"Mondesert","sequence":"additional","affiliation":[{"name":"Department of Medicine, Montreal Heart Institute, Universit\u00e9 de Montr\u00e9al , Montreal, Quebec ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacinthe","family":"Boulet","sequence":"additional","affiliation":[{"name":"Department of Medicine, Montreal Heart Institute, Universit\u00e9 de Montr\u00e9al , Montreal, Quebec ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6600-1258","authenticated-orcid":false,"given":"Pierre-Emmanuel","family":"Noly","sequence":"additional","affiliation":[{"name":"Department of Medicine, Montreal Heart Institute, Universit\u00e9 de Montr\u00e9al , Montreal, Quebec ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois","family":"Picard","sequence":"additional","affiliation":[{"name":"IHU LIRYC, CHU Bordeaux. 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