Aditya A Joshi1,2,3, Joseph B Lerman4, Aparna P Sajja5, Garima Dahiya1, Avantee V Gokhale6, Amit K Dey7, Andreas Kyvernitakis2, M Scott Halbreiner8, Stephen Bailey8, Craig M Alpert2, Indu G Poornima2, Srinivas Murali2, Raymond L Benza2, Manreet Kanwar2, Amresh Raina2. 1. Institute of Internal Medicine (A.A.J., G.D.), Allegheny General Hospital, Pittsburgh, PA. 2. Cardiovascular Institute (A.A.J., A.K., C.M.A., I.G.P., S.M., R.L.B., M.K., A.R.), Allegheny General Hospital, Pittsburgh, PA. 3. Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Heart at Mount Sinai St Luke's Hospital, New York, NY (A.A.J.). 4. Department of Internal Medicine, Duke University Medical Center, Durham, NC (J.B.L.). 5. Department of Internal Medicine, Johns Hopkins University Medical Center, Baltimore, MD (A.P.S.). 6. Department of Nephrology, Icahn School of Medicine at Mount Sinai, New York, NY (A.V.G.). 7. National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (A.K.D.). 8. Division of Cardiac Surgery (M.S.H., S.B.), Allegheny General Hospital, Pittsburgh, PA.
Abstract
BACKGROUND: Women comprise approximately one-third of the advanced heart failure population but may receive fewer advanced heart failure therapies including left ventricular assist devices (LVADs). During the early pulsatile-flow device era, women had higher post-LVAD mortality and increased complications. However, knowledge about these differences in the continuous-flow device era is limited. Therefore, we sought to explore temporal trends in LVAD utilization and post-LVAD mortality by sex. METHODS AND RESULTS: Patients with LVAD implantation from 2004 to 2016 were identified using the Nationwide Inpatient Sample. Trends in LVAD utilization and post-LVAD inpatient mortality were compared by sex and device era. Although LVADs are being increasingly utilized for patients with advanced systolic heart failure, women continue to represent a smaller proportion of LVAD recipients-25.8% in 2004 to 21.9% in 2016 (P for trend, 0.91). Women had increased inpatient mortality after LVAD implantation compared with men in the pulsatile-flow era (46.9% versus 31.1%, P<0.0001) but not in the continuous-flow era (13.3% versus 12.1%, P=0.27; P for interaction=0.0002). Inpatient mortality decreased for both sexes over time after LVAD, with a sharp fall in 2008 to 2009. Female sex was independently associated with increased post-LVAD inpatient mortality beyond adjustment for demographics and risk factors during the pulsatile-flow era (odds ratio, 2.13; 95% CI, 1.45-3.10; P<0.0001) but not during the continuous-flow era (1.18; 0.93-1.48; P=0.16). CONCLUSIONS: Although utilization of LVAD therapy increased over time for both sexes, LVAD implantation remains stably lower in women, which may suggest a potential underutilization of this potentially life-saving therapy. Prospective studies are needed to confirm these findings.
BACKGROUND:Women comprise approximately one-third of the advanced heart failure population but may receive fewer advanced heart failure therapies including left ventricular assist devices (LVADs). During the early pulsatile-flow device era, women had higher post-LVADmortality and increased complications. However, knowledge about these differences in the continuous-flow device era is limited. Therefore, we sought to explore temporal trends in LVAD utilization and post-LVADmortality by sex. METHODS AND RESULTS:Patients with LVAD implantation from 2004 to 2016 were identified using the Nationwide Inpatient Sample. Trends in LVAD utilization and post-LVAD inpatient mortality were compared by sex and device era. Although LVADs are being increasingly utilized for patients with advanced systolic heart failure, women continue to represent a smaller proportion of LVAD recipients-25.8% in 2004 to 21.9% in 2016 (P for trend, 0.91). Women had increased inpatient mortality after LVAD implantation compared with men in the pulsatile-flow era (46.9% versus 31.1%, P<0.0001) but not in the continuous-flow era (13.3% versus 12.1%, P=0.27; P for interaction=0.0002). Inpatient mortality decreased for both sexes over time after LVAD, with a sharp fall in 2008 to 2009. Female sex was independently associated with increased post-LVAD inpatient mortality beyond adjustment for demographics and risk factors during the pulsatile-flow era (odds ratio, 2.13; 95% CI, 1.45-3.10; P<0.0001) but not during the continuous-flow era (1.18; 0.93-1.48; P=0.16). CONCLUSIONS: Although utilization of LVAD therapy increased over time for both sexes, LVAD implantation remains stably lower in women, which may suggest a potential underutilization of this potentially life-saving therapy. Prospective studies are needed to confirm these findings.
Entities:
Keywords:
heart failure; heart-assist devices; mortality; sex; women
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