Sex differences in eligibility for advanced heart failure therapies.
disparities
heart failure
heart transplant
left ventricular assist device
women
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
02
12
2019
revised:
03
02
2020
accepted:
16
02
2020
pubmed:
20
2
2020
medline:
29
5
2021
entrez:
20
2
2020
Statut:
ppublish
Résumé
We investigated sex-based differences in eligibility for and outcomes after receipt of advanced heart failure (HF) therapies. Although women are more likely to die from HF than men, registry data suggest that women are less likely to receive heart transplant (HT) or left ventricular assist device (LVAD) for largely unknown reasons. We performed a single-center retrospective cohort study of patients evaluated for advanced HF therapies from 2012 to 2016. Logistic regression was used to determine the association of sex with eligibility for HT/LVAD. Competing risks and Kaplan-Meier analysis were used to examine survival. Of 569 patients (31% women) evaluated, 223 (39.2%) were listed for HT and 81 (14.2%) received destination (DT) LVAD. Women were less likely to be listed for HT (adjusted odds ratio [OR] 0.36, 95% confidence interval [CI] 0.21-0.61; P < .0001), based on allosensitization (P < .0001) and obesity (P = .02). Women were more likely to receive DT LVAD (adjusted OR 2.29, 95% CI 1.23-4.29; P = .01). Survival was similar between men and women regardless of whether they received HT and DT LVAD or were ineligible for therapy. Women are less likely to be HT candidates, but more likely to receive DT LVAD.
Sections du résumé
OBJECTIVES
We investigated sex-based differences in eligibility for and outcomes after receipt of advanced heart failure (HF) therapies.
BACKGROUND
Although women are more likely to die from HF than men, registry data suggest that women are less likely to receive heart transplant (HT) or left ventricular assist device (LVAD) for largely unknown reasons.
METHODS
We performed a single-center retrospective cohort study of patients evaluated for advanced HF therapies from 2012 to 2016. Logistic regression was used to determine the association of sex with eligibility for HT/LVAD. Competing risks and Kaplan-Meier analysis were used to examine survival.
RESULTS
Of 569 patients (31% women) evaluated, 223 (39.2%) were listed for HT and 81 (14.2%) received destination (DT) LVAD. Women were less likely to be listed for HT (adjusted odds ratio [OR] 0.36, 95% confidence interval [CI] 0.21-0.61; P < .0001), based on allosensitization (P < .0001) and obesity (P = .02). Women were more likely to receive DT LVAD (adjusted OR 2.29, 95% CI 1.23-4.29; P = .01). Survival was similar between men and women regardless of whether they received HT and DT LVAD or were ineligible for therapy.
CONCLUSION
Women are less likely to be HT candidates, but more likely to receive DT LVAD.
Identifiants
pubmed: 32073188
doi: 10.1111/ctr.13839
pmc: PMC7323365
mid: NIHMS1572065
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13839Subventions
Organisme : NHLBI NIH HHS
ID : K23 HL124287
Pays : United States
Organisme : NIMHD NIH HHS
ID : U54 MD008173
Pays : United States
Informations de copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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