Abstract 4143207: Time in Target Mean Arterial Pressure Range and Mortality in HeartMate 3 LVAD Recipients

Background: The HeartMate 3 Device (HM3) is an afterload-sensitive left ventricular assist device (LVAD). International guidelines suggest a target Doppler blood pressure (BP) range between 70-90 mmHg, though this recommendation is supported mostly by expert consensus. Optimal real-world data remains lacking regarding the ideal BP for these patients. Remote patient monitoring (RPM) can be utilized for outpatient Doppler blood pressure monitoring. We aimed to evaluate the association between time spent in goal BP range and mortality in HM3 LVAD recipients. Methods: 1,427 HM3 LVAD recipients from 74 centers using the ActiCare Health RPM system, which allows patients to measure Doppler BP and upload results to their care team, were included in this analysis. Inclusion criteria included patients with at least two BP measurements. Outpatient Doppler BP values were collected, and a standard therapeutic range (70–90 mmHg) was established. The percentage of time in the therapeutic range (TTR) was calculated, categorizing patients as ≥75%, 50-75%, and ≤50%. Survival at 600 days on LVAD support and reporting frequencies were compared between groups. Results: We studied 738 HM3 LVAD recipients, implanted from 2015 to 2024, with a mean duration of 715 ± 19 days on LVAD support. 140 (19%) patients died. A total of 144,562 Doppler BP readings were analyzed, with a mean value of 82.8 ± 0.02 mmHg. There were 481 patients with TTR ≥75% (65%), 138 patients with TTR 50-75% (19%), and 119 patients with TTR ≤50% (16%). There was a significantly greater probability of survival for those with TTR ≥75% compared to ≤50% (94% vs. 85% at 400 days and 88% vs. 84% at 600 days, p = 0.05, Figure). The mean number of BP submissions per 100 days for the ≥75% group was 37.8 ± 0.87, compared to 25.8 ± 0.87 in the 50-75% group and 21.7 ± 1.25 in the ≤50% group (p < 0.001). Discussion: The data suggest that HM3 patients who spend more than 75% of the time with a Doppler BP between 70-90 mmHg have greater survival compared to those who are within range less than 50% of the time. RPM can be used for closer monitoring of Doppler BP in HM3 LVAD recipients. Patients with Doppler BP 70-90 mmHg may have improved survival.