Sex-related differences in left ventricular assist device utilization and outcomes: results from the PCHF-VAD registry.
Advanced heart failure
Left ventricular assist device
Sex
Survival
Utilization
Journal
ESC heart failure
ISSN: 2055-5822
Titre abrégé: ESC Heart Fail
Pays: England
ID NLM: 101669191
Informations de publication
Date de publication:
04 2023
04 2023
Historique:
revised:
05
10
2022
received:
23
06
2022
accepted:
27
11
2022
medline:
30
3
2023
pubmed:
23
12
2022
entrez:
22
12
2022
Statut:
ppublish
Résumé
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. 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. 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.
Identifiants
pubmed: 36547014
doi: 10.1002/ehf2.14261
pmc: PMC10053365
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1054-1065Informations de copyright
© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Références
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
N Engl J Med. 2019 Apr 25;380(17):1618-1627
pubmed: 30883052
J Heart Lung Transplant. 2015 Dec;34(12):1570-7
pubmed: 26508726
Ann Thorac Surg. 2017 Jan;103(1):106-112
pubmed: 27577033
J Heart Lung Transplant. 2015 Dec;34(12):1495-504
pubmed: 26520247
J Card Fail. 2015 Oct;21(10):835-9
pubmed: 26112460
J Card Fail. 2006 Mar;12(2):100-7
pubmed: 16520256
J Card Fail. 2020 Jun;26(6):494-504
pubmed: 32200097
J Thorac Cardiovasc Surg. 2016 Jan;151(1):177-89
pubmed: 26545967
Am J Cardiol. 2017 Jan 15;119(2):297-301
pubmed: 27839770
Heart. 2006 May;92 Suppl 3:iii14-8
pubmed: 16614262
J Heart Lung Transplant. 2015 Dec;34(12):1611-6
pubmed: 26212658
J Am Coll Cardiol. 2003 Jan 15;41(2):217-23
pubmed: 12535812
Circ Heart Fail. 2021 Sep;14(9):e008242
pubmed: 34407626
ESC Heart Fail. 2023 Apr;10(2):884-894
pubmed: 36460627
J Heart Lung Transplant. 2017 Jan;36(1):64-70
pubmed: 27793517
Arch Intern Med. 2001 Apr 9;161(7):996-1002
pubmed: 11295963
Eur Heart J. 2019 Feb 21;40(8):673-677
pubmed: 28329374
Am Heart J. 2009 Oct;158(4 Suppl):S16-23
pubmed: 19782784
Eur J Heart Fail. 2018 Jan;20(1):152-160
pubmed: 28960673
Eur Heart J. 2004 Sep;25(18):1614-9
pubmed: 15351160
ASAIO J. 2018 Jul/Aug;64(4):440-449
pubmed: 29084066
Circulation. 2002 Dec 10;106(24):3068-72
pubmed: 12473553
J Heart Lung Transplant. 2018 Jan;37(1):7-14
pubmed: 29154131
ASAIO J. 2022 Jan 1;68(1):21-27
pubmed: 34156789
J Card Surg. 2013 Sep;28(5):604-10
pubmed: 23844652
Circ Heart Fail. 2019 Sep;12(9):e006082
pubmed: 31514517
Europace. 2015 Mar;17(3):424-31
pubmed: 25164429
Transplantation. 2010 Jan 27;89(2):236-44
pubmed: 20098289
Eur J Heart Fail. 2019 Sep;21(9):1129-1141
pubmed: 31410955
ESC Heart Fail. 2023 Apr;10(2):1054-1065
pubmed: 36547014
JAMA. 2022 Sep 27;328(12):1233-1242
pubmed: 36074476
J Heart Lung Transplant. 2015 Sep;34(9):1123-30
pubmed: 26267741
Circulation. 2005 Aug 30;112(9 Suppl):I37-45
pubmed: 16159848
Heart. 2008 Mar;94(3):e10
pubmed: 17575332
J Heart Lung Transplant. 2018 Jan;37(1):61-70
pubmed: 28754423
Eur J Heart Fail. 2017 Oct;19(10):1270-1279
pubmed: 28176416
J Card Fail. 2009 Aug;15(6):501-7
pubmed: 19643361
Eur Heart J. 2019 Dec 14;40(47):3859-3868c
pubmed: 31800034
Clin Med Insights Cardiol. 2015 May 21;9(Suppl 2):7-14
pubmed: 26052233
JACC Heart Fail. 2019 Mar;7(3):250-257
pubmed: 30819381
Eur J Prev Cardiol. 2021 Aug 9;28(9):957-965
pubmed: 34402878
Eur J Heart Fail. 2022 Jul;24(7):1305-1315
pubmed: 35508920
J Womens Health (Larchmt). 2018 May;27(5):623-629
pubmed: 29319404
Circulation. 2007 Mar 27;115(12):1563-70
pubmed: 17353436
Am Heart J. 2008 Feb;155(2):339-47
pubmed: 18215606
JACC Heart Fail. 2020 Sep;8(9):770-779
pubmed: 32653446