TY - JOUR
T1 - Sex-related differences in left ventricular assist device utilization and outcomes: results from the PCHF-VAD registry
AU - Radhoe, Sumant P
AU - Jakus, Nina
AU - Veenis, Jesse F
AU - Timmermans, Philippe
AU - Pouleur, Anne-Catherine
AU - Rubís, Pawel
AU - Van Craenenbroeck, Emeline M
AU - Gaizauskas, Edvinas
AU - Barge-Caballero, Eduardo
AU - Paolillo, Stefania
AU - Grundmann, Sebastian
AU - D'AMARIO, DOMENICO
AU - Braun, Oscar Ö
AU - Gkouziouta, Aggeliki
AU - Planinc, Ivo
AU - Macek, Jana Ljubas
AU - Meyns, Bart
AU - Droogne, Walter
AU - Wierzbicki, Karol
AU - Holcman, Katarzyna
AU - Flammer, Andreas J
AU - Gasparovic, Hrvoje
AU - Biocina, Bojan
AU - Milicic, Davor
AU - Lund, Lars H
AU - Ruschitzka, Frank
AU - Brugts, Jasper J
AU - Cikes, Maja
PY - 2023
Y1 - 2023
N2 - AimsData on sex and left ventricular assist device (LVAD) utilization and outcomes have been conflicting and mostly confined to US studies incorporating older devices. This study aimed to investigate sex-related differences in LVAD utilization and outcomes in a contemporary European LVAD cohort. Methods and resultsThis analysis is part of the multicentre PCHF-VAD registry studying continuous-flow LVAD patients. The primary outcome was all-cause mortality. Secondary outcomes included ventricular arrhythmias, right ventricular failure, bleeding, thromboembolism, and the haemocompatibility score. Multivariable Cox regression models were used to assess associations between sex and outcomes. Overall, 457 men (81%) and 105 women (19%) were analysed. At LVAD implant, women were more often in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 or 2 (55% vs. 41%, P = 0.009) and more often required temporary mechanical circulatory support (39% vs. 23%, P = 0.001). Mean age was comparable (52.1 vs. 53.4 years, P = 0.33), and median follow-up duration was 344 [range 147-823] days for women and 435 [range 190-816] days for men (P = 0.40). No significant sex-related differences were found in all-cause mortality (hazard ratio [HR] 0.79 for female vs. male sex, 95% confidence interval [CI] [0.50-1.27]). Female LVAD patients had a lower risk of ventricular arrhythmias (HR 0.56, 95% CI [0.33-0.95]) but more often experienced right ventricular failure. No significant sex-related differences were found in other outcomes. ConclusionsIn this contemporary European cohort of LVAD patients, far fewer women than men underwent LVAD implantation despite similar clinical outcomes. This is important as the proportion of female LVAD patients (19%) was lower than the proportion of females with advanced HF as reported in previous studies, suggesting underutilization. Also, female patients were remarkably more often in INTERMACS profile 1 or 2, suggesting later referral for LVAD therapy. Additional research in female patients is warranted.
AB - AimsData on sex and left ventricular assist device (LVAD) utilization and outcomes have been conflicting and mostly confined to US studies incorporating older devices. This study aimed to investigate sex-related differences in LVAD utilization and outcomes in a contemporary European LVAD cohort. Methods and resultsThis analysis is part of the multicentre PCHF-VAD registry studying continuous-flow LVAD patients. The primary outcome was all-cause mortality. Secondary outcomes included ventricular arrhythmias, right ventricular failure, bleeding, thromboembolism, and the haemocompatibility score. Multivariable Cox regression models were used to assess associations between sex and outcomes. Overall, 457 men (81%) and 105 women (19%) were analysed. At LVAD implant, women were more often in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1 or 2 (55% vs. 41%, P = 0.009) and more often required temporary mechanical circulatory support (39% vs. 23%, P = 0.001). Mean age was comparable (52.1 vs. 53.4 years, P = 0.33), and median follow-up duration was 344 [range 147-823] days for women and 435 [range 190-816] days for men (P = 0.40). No significant sex-related differences were found in all-cause mortality (hazard ratio [HR] 0.79 for female vs. male sex, 95% confidence interval [CI] [0.50-1.27]). Female LVAD patients had a lower risk of ventricular arrhythmias (HR 0.56, 95% CI [0.33-0.95]) but more often experienced right ventricular failure. No significant sex-related differences were found in other outcomes. ConclusionsIn this contemporary European cohort of LVAD patients, far fewer women than men underwent LVAD implantation despite similar clinical outcomes. This is important as the proportion of female LVAD patients (19%) was lower than the proportion of females with advanced HF as reported in previous studies, suggesting underutilization. Also, female patients were remarkably more often in INTERMACS profile 1 or 2, suggesting later referral for LVAD therapy. Additional research in female patients is warranted.
KW - Advanced heart failure
KW - Left ventricular assist device
KW - Sex
KW - Survival
KW - Utilization
KW - Advanced heart failure
KW - Left ventricular assist device
KW - Sex
KW - Survival
KW - Utilization
UR - https://iris.uniupo.it/handle/11579/181902
U2 - 10.1002/ehf2.14261
DO - 10.1002/ehf2.14261
M3 - Article
SN - 2055-5822
VL - 10
JO - ESC heart failure
JF - ESC heart failure
IS - 2
ER -