Sex-Based Differences in Clinical Outcomes of Stroke Related to LVAD

Abstract

<h3>Purpose</h3> Sex-based differences among patients with left ventricular assist devices (LVAD) having stroke are uncertain. We aimed to compare demographic and clinical characteristics, inpatient outcomes, and measures of health care utilization among men and women who had stroke while undergoing LVAD implantation. <h3>Methods</h3> We analyzed the National Inpatient Sample from 2009 and 2019) to identify patients with stroke while on LVAD utilizing ICD Codes. The data were weighted to reflect national estimates. Outcomes of interest include inpatient mortality, clinical complications, length of stay (LOS), and inflation-adjusted care costs among men vs. women. <h3>Results</h3> A total of 2192 hospitalizations (556 females and 1636 males) were included in this analysis. Most strokes occurred in men vs. women (75% vs. 25%). Women patients were younger (51 y vs. 59 yr); Black women had a higher likelihood of stroke than Black men (32.4% vs. 15.6%). Men had a higher burden of cardiometabolic comorbidities (hypertension, diabetes, ischemic heart disease) than women. While there were no significant differences regarding ischemic stroke, women had higher odds of hemorrhagic stroke than men (1.49 [CI: 1.02-2.18]). Between 2010 and 2019, stroke rates have significantly increased among men, while the trend remained stable in women (<b>Figure</b>). There was no significant difference in all-cause mortality or clinical complications (cardiac arrest, invasive mechanical ventilation, pressors, dialysis). <h3>Conclusion</h3> In this national analysis, men had a higher comorbidity burden, translating into worsening stroke trends over the last 10 years than women with LVAD and stroke. In contrast, women were younger, exhibited racial disparities, and had a higher risk of hemorrhagic stroke. A deeper understanding of factors influencing sex-related outcomes may explain diverging trends among men and women.