Sex differences in eligibility for advanced heart failure therapies

• Authors: Rebecca S. Steinberg, Emory University; Aditi Nayak, Emory University; Celena O'Connell, Emory Healthcare; Sharon Burford, Emory Healthcare; Ann Pekarek, Emory Healthcare; Neile Chesnut, Emory Healthcare; Robert Cole, Emory University; Divya Gupta, Emory University; Sonjoy Laskar, Emory University; Kunal Bhatt, Emory University; Michael Burke, Emory University; Tamer Attia, Emory University; Andrew Smith, Emory University; John Vega, Emory University; Alanna Morris, Emory University
• Journal Title: Clinical Transplantation
• Volume: Volume 34, Number 5
• Publisher: Wiley | 2020-05-01, Pages e13839-e13839
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1111/ctr.13839
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management; Health Sciences, Rehabilitation and Therapy
• Keywords: Science & Technology; Life Sciences & Biomedicine; Surgery; Transplantation; disparities; heart failure; heart transplant; left ventricular assist device; women; Ventricular assist device; International society; Gender differences; Transplantation; Outcomes; Support; Guidelines; Antibody; Registry; Stroke

Abstract

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<0.0001), based on allosensitization (P<0.0001) and obesity (P=0.02). Women were more likely to receive DT LVAD (adjusted OR 2.29, 95% CI 1.23 – 4.29; P=0.01). Survival was similar between men and women regardless of whether they received HT, DT LVAD, or were ineligible for therapy. Conclusion: Women are less likely to be HT candidates, but more likely to receive DT LVAD.