Sex-Based Differences in Patients With Left Ventricular-Assisted Devices and Strokes
Salma Zook1, Otito Ojukwu2, Safi U Khan1
1Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA.
Insights
Men with left ventricular assist device (LVAD) implants experienced worsening stroke trends and higher comorbidity burdens. Women had fewer LVADs and a higher risk of hemorrhagic stroke, highlighting critical sex-based outcome disparities.
Area of Science:
- Cardiology
- Neurology
- Health Services Research
Background:
- Sex-based differences in clinical outcomes among patients with left ventricular assist device (LVAD) related stroke are not well described.
- Understanding these disparities is crucial for improving patient care and outcomes.
Purpose of the Study:
- To examine sex-based differences in clinical characteristics and outcomes of patients who experienced stroke during LVAD hospitalization.
- To identify trends in stroke incidence and associated factors between men and women.
Main Methods:
- Utilized the National Inpatient Sample (2010-2019) to identify patients with stroke during LVAD hospitalization.
- Analyzed inpatient mortality and clinical complications, comparing men and women.
- Employed weighted logistic regression, adjusting for age and the Elixhauser comorbidity index.
Main Results:
- Women experiencing stroke were younger (51 years) than men (59 years).
- Men had a higher comorbidity burden; women had higher odds of hemorrhagic stroke (OR: 1.49).
- Stroke rates significantly increased among men between 2010-2019, while trends varied for women.
Conclusions:
- Men exhibit higher comorbidity burdens and worsening stroke trends post-LVAD implantation.
- Women, despite fewer LVADs, present with a higher incidence of hemorrhagic stroke.
- Addressing sex-related outcome disparities in LVAD stroke patients is critical for targeted interventions.
Background:
Sex-based differences in clinical outcomes among patients with stroke related to left ventricular assist devices (LVADs) are not well described.
Objectives:
In this study, the authors examined differences in clinical characteristics and outcomes in men and women who had a stroke during LVAD hospitalization.
Methods:
The National Inpatient Sample from 2010 and 2019 was used to identify patients with stroke during LVAD hospitalization. Outcomes of interest include inpatient mortality and clinical complications among men vs women. Weighted logistic regression was used to determine the association of sex and outcomes. Adjustments were made for age and the Elixhauser comorbidity index.
Results:
In total, 35,820 patients underwent LVAD implantation (77% men), and 6.12% (n = 2,192) of patients experienced stroke. Women who had stroke were younger than men who had stroke (mean age in women was 51 years vs men 59 years, P < 0.001). Men with strokes had a higher burden of comorbidities than women. While there were no differences in the odds of ischemic stroke, women had higher odds of hemorrhagic stroke compared to men (OR: 1.49 [95% CI: 1.02-2.18]). Mortality in patients with LVAD who had stroke was significantly higher than in those without stroke. Between 2010 and 2019, stroke rates significantly increased among men, while the trend remained variable among women.
Conclusions:
In this national cohort, men had a higher comorbidity burden and had worsening stroke trends over the last decade compared to women. Women had fewer LVAD implants and a higher incidence of hemorrhagic stroke. Understanding the factors that contribute to sex-related outcome disparities among LVAD stroke patients is crucial in addressing these diverging trends.
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