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Sex difference in the impact of smoking on left ventricular assist device outcomes
Teruhiko Imamura1,2, Pamela Combs3, Umar Siddiqi3
1Department of Cardiology, University of Chicago Medical Center, Chicago, Illinois.
Insights
Active smoking worsens outcomes for male patients with left ventricular assist devices (LVADs). Female patients experienced high adverse events regardless of smoking status, suggesting a need for gender-specific approaches.
Area of Science:
- Cardiology
- Thoracic Surgery
- Medical Device Research
Background:
- Active smoking is linked to poorer outcomes after left ventricular assist device (LVAD) implantation.
- The interplay between sex and smoking status on LVAD outcomes is not well understood.
Purpose of the Study:
- To investigate the impact of smoking status on clinical outcomes in male and female patients undergoing LVAD implantation.
- To determine if sex differences modify the association between smoking and adverse events post-LVAD.
Main Methods:
- Retrospective analysis of consecutive patients who received LVADs between January 2013 and September 2018.
- Comparison of clinical outcomes between current smokers and never-smokers within separate male and female cohorts.
Main Results:
- In the male cohort (N=85), current smokers (N=25) exhibited a significantly higher total readmission rate (IRR 2.38, P=.014) due to gastrointestinal bleeding, stroke, and hemolysis.
- In the female cohort (N=45), no statistically significant difference in total readmission rates was observed between never-smokers (N=36) and current smokers (N=9) (2.80 vs 2.50 events/year; P=.37).
Conclusions:
- Active smoking is associated with increased adverse events in male LVAD patients.
- Female LVAD patients face high adverse event rates irrespective of smoking status.
- Gender-specific therapeutic strategies may be necessary to mitigate LVAD-related complications.
Background:
Active smoking is associated with worse clinical outcomes following left ventricular assist device (LVAD) implantation. However, the effect of sex differences in conjunction with smoking status remains uninvestigated.
Methods:
Consecutive patients who underwent LVAD implantation between January 2013 and September 2018 were included. Clinical outcomes were retrospectively compared between the current smokers and never smokers among male cohorts and female cohorts separately.
Results:
About 130 patients, with a median age of 56 years, were included. Among the male cohort (N = 85), the current smokers (N = 25/85) had a higher total readmission rate than the never smokers (N = 60/85) with an adjusted incidence rate ratio of 2.38 (95% confidence interval, 1.16-3.85, P = .014), dominantly due to higher rates of gastrointestinal bleeding, stroke, and hemolysis. Among the female cohorts (N = 45), never smokers (N = 36/45) had a statistically comparable total readmission rate (2.80 vs 2.50 events per year; P = .37) compared with current smokers (N = 9/45).
Conclusion:
Among male patients with LVAD, active smoking was associated with higher rates of adverse events. Female patients with LVAD had a high rate of adverse events irrespective of smoking status. Gender-specific therapeutic approaches might be required to prevent LVAD-related comorbidities.
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