Abstract 11040: Gender Imbalance in Heart Failure Treatment, Use of Implantable Left Ventricular Assist Systems, and Cardiac Transplantation

Abstract

Introduction: Fewer women than men with heart failure (HF) progress to implantation of a left ventricular assist device (LVAD) or transplant. A comprehensive, large-database analysis of women with HF is lacking. Methods: From a commercial and a national Medicare database using OPTUM® Clinformatic® Data Mart and a Medicare National Sample comprising 57,585,519 US patients, we identified 346,345 adults treated for HF during 2014-2016. Comorbidities including diabetes, coronary artery disease, hypertension, and cardiomyopathy were recorded. Patients were monitored for stroke, mechanical ventilation, heart transplant, renal insufficiency, and death through 2019 or until they were no longer enrolled. Sex and age were discerned from enrollment information. Results: Approximately equal percentages of men (51%) and women (49%) had HF. Age at HF diagnosis was similar between men and women (60 vs 58 y). Diastolic HF was more common in women than in men prior to LVAD placement (64% vs 36%) . All patients who progressed to LVAD placement had combined systolic and diastolic heart failure. Similar numbers of men and women with HF died within the follow-up period. Women received only 24% of the implanted LVADs. Age at LVAD placement was similar between men and women (61 vs 59 y). More men than women with HF and implanted LVADs had coronary artery disease and ischemic cardiomyopathy. After LVAD implantation, intracerebral bleeding and stroke were more common in women. Conclusions: In the largest database analysis to date, HF incidence, age at diagnosis, and age at LVAD placement were similar between women and men. Fewer women progressed to LVAD placement or transplantation. The prevalence of diastolic HF was significantly higher in women prior to LVAD placement. Women’s outcomes after LVAD implantation were significantly worse than men’s, especially with regard to stroke and cerebral injury. These findings support those of smaller studies.