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Published on: August 16, 2021
Sex-based Differences in the Utility and Outcomes of Left Ventricular Assist Devices
Mirvat Alasnag1, Waleed AlHabeeb2, Feras Khaliel3
1Cardiac Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
Insights
Women receive fewer left ventricular assist devices (LVADs) and heart transplants (HT) than men, increasing their waitlist mortality. This disparity in advanced heart failure therapies needs urgent investigation to improve care.
Area of Science:
- Cardiology
- Medical Devices
- Health Equity
Background:
- Significant sex-based disparities exist in advanced heart failure treatment.
- Women face challenges in accessing left ventricular assist devices (LVADs) and heart transplantation (HT).
Purpose of the Study:
- To investigate the persistent disparities in LVAD and HT utilization between men and women.
- To identify factors contributing to sex-related differences in advanced heart failure therapy assignment.
Main Methods:
- Analysis of existing evidence on LVAD and HT use in men versus women.
- Accounting for baseline characteristics, comorbidities, and cardiovascular risk factors.
Main Results:
- Women are less likely to receive LVADs and HT compared to men.
- Disparities persist even after adjusting for clinical differences.
- Women experience higher mortality rates on the heart transplant waiting list.
Conclusions:
- Sex-related disparities in advanced heart failure device therapy persist.
- Differences in risk profiles and complications may explain these gaps.
- Prospective studies are needed to define causes and establish guidelines to reduce disparities.
Abstract:
The totality of evidence suggests that there remains a significant disparity in the use of left ventricular assist devices (LVADs) and heart transplantation (HT) in women. This disparity persists even after accounting for differences in baseline characteristics, comorbidities, and cardiovascular risk factors between men and women undergoing LVAD implantation as a bridge to HT. Generally, women are less likely to undergo HT, leading to a higher mortality rate in women on the HT waiting list. The differences in risk profiles and device-related complications may account for the sexrelated disparities in the assignment of device therapies. These findings warrant an urgent need to conduct prospective studies to better define this conundrum and establish guidelines to narrow the current gaps in care.
