Sex-related differences in left ventricular assist device utilization and outcomes : results from the PCHF-VAD registry
(2023) In ESC Heart Failure 10(2). p.1054-1065- Abstract
Aims: Data 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 results: This 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%)... (More)
Aims: Data 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 results: This 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. Conclusions: In 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.
(Less)
- author
- organization
- publishing date
- 2023-04
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Advanced heart failure, Left ventricular assist device, Sex, Survival, Utilization
- in
- ESC Heart Failure
- volume
- 10
- issue
- 2
- pages
- 12 pages
- publisher
- John Wiley & Sons Inc.
- external identifiers
-
- pmid:36547014
- scopus:85145068283
- ISSN
- 2055-5822
- DOI
- 10.1002/ehf2.14261
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
- id
- 3c22252f-a184-4a4c-a718-dd4dd5d6ae25
- date added to LUP
- 2024-01-12 12:39:42
- date last changed
- 2024-04-13 06:08:27
@article{3c22252f-a184-4a4c-a718-dd4dd5d6ae25,
abstract = {{<p>Aims: Data 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 results: This 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. Conclusions: In 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.</p>}},
author = {{Radhoe, Sumant P. and Jakus, Nina and Veenis, Jesse F. and Timmermans, Philippe and Pouleur, Anne Catherine and Rubís, Pawel and Van Craenenbroeck, Emeline M. and Gaizauskas, Edvinas and Barge-Caballero, Eduardo and Paolillo, Stefania and Grundmann, Sebastian and D'Amario, Domenico and Braun, Oscar and Gkouziouta, Aggeliki and Planinc, Ivo and Macek, Jana Ljubas and Meyns, Bart and Droogne, Walter and Wierzbicki, Karol and Holcman, Katarzyna and Flammer, Andreas J. and Gasparovic, Hrvoje and Biocina, Bojan and Milicic, Davor and Lund, Lars H and Ruschitzka, Frank and Brugts, Jasper J. and Cikes, Maja}},
issn = {{2055-5822}},
keywords = {{Advanced heart failure; Left ventricular assist device; Sex; Survival; Utilization}},
language = {{eng}},
number = {{2}},
pages = {{1054--1065}},
publisher = {{John Wiley & Sons Inc.}},
series = {{ESC Heart Failure}},
title = {{Sex-related differences in left ventricular assist device utilization and outcomes : results from the PCHF-VAD registry}},
url = {{http://dx.doi.org/10.1002/ehf2.14261}},
doi = {{10.1002/ehf2.14261}},
volume = {{10}},
year = {{2023}},
}