Sex-Based Differences in Survival and Readmissions After Insertion of HeartMate3 (HM3) Left Ventricular Assist Device

Abstract

<h3>Purpose</h3> Left ventricular assist device (LVAD) technology remains underutilized among women with advanced heart failure, likely biased by concerns for increased risk in this population. We investigated survival and cumulative incidence of readmission in LVAD patients separated by sex. <h3>Methods</h3> We retrospectively reviewed all patients who underwent HM3 LVAD implantation from 11/26/14 to 12/4/19 at a single large-volume center. All unplanned readmissions up to 900-days of follow up were analyzed. Readmissions were categorized based on INTERMACS criteria into: major bleeding, infection, arrhythmia, volume overload, device-related complications and other causes. Survival was evaluated by KM method. Incidence of all-cause readmission was evaluated using mean cumulative function method. <h3>Results</h3> Of 182 HM3 pts, 30 were women and 152 were men. Relative to women, men were more commonly white (65.1% vs 30.0%, p=0.0003), had ischemic cardiomyopathy (42.8% vs 16.7%, p=0.007) and higher baseline serum creatinine (1.45(1.2-1.8) vs 1.12(0.81-1.4)mg/dL, p<0.0001). Overall survival during index admission and at 900-days was similar (women vs men: 93.3% vs 94.1%, p=0.9; 83.3% vs 83.0%, p=0.9, respectively (<b>Figure 1A</b>). Cumulative incidence of all-cause readmissions was similar (p=0.55). Readmissions separated by etiology were also similar, except women had a greater incidence of device-related readmissions (19.7% vs 11.3%, p=0.05) (<b>Figure 1B</b>). The most common reason among device-related readmissions was low flow alarm. Median time to first readmission (p=0.56) and length of stay during index admission (p=0.66) was similar. <h3>Conclusion</h3> Women have similar survival during index admission and at 900-days of follow up. Cumulative incidence of all-cause readmission did not differ by sex, however women were more commonly admitted with device-related complications. Future investigations into the sex related LVAD outcomes is critical to avoid this treatment disparity.