Gender differences in the risk of stroke during support with continuous-flow left ventricular assist device

• Published in: The Journal of heart and lung transplantation Vol. 34; no. 12; pp. 1570 - 1577
• Main Authors: Morris, Alanna A., MD, Pekarek, Ann, RN, Wittersheim, Kris, RN, Cole, Robert T., MD, Gupta, Divya, MD, Nguyen, Duc, MD, Laskar, S. Raja, MD, Butler, Javed, MD, MPH, Smith, Andrew, MD, Vega, J. David, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2015
• Subjects: Female; gender; healthcare disparities; heart failure; Heart-Assist Devices - adverse effects; Humans; left ventricular assist device; Male; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - etiology; prognosis; Retrospective Studies; Risk Factors; Sex Distribution; Sex Factors; stroke; Stroke - epidemiology; Stroke - etiology; Surgery; heart failure; risk factors; gender; healthcare disparities; left ventricular assist device; stroke; prognosis
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2015.08.013

Background There is increasing recognition that the risk of stroke after left ventricular assist device (LVAD) implantation varies based on gender, with a higher risk in female patients. We reviewed our own data to determine gender differences in the risk of stroke. Methods Frequency of stroke, including intracranial hemorrhage and ischemic stroke, was retrospectively evaluated in 110 heart failure patients (mean age 49.6 ± 13.6 years, 32% women) discharged from the hospital after implantation of a HeartMate II ( N = 74) or HeartWare ( N = 36) LVAD. Competing outcomes analysis was used to determine which clinical risk factors were associated with the risk of stroke and death, with the primary end-point being time to first stroke event. Results During a median follow-up of 1.3 years, 26 patients had a stroke (23.6%, 0.14 case per person-year). The median time to first stroke was 0.7 (interquartile range 0.3 to 1.4) years. After adjusting for covariates, risk of stroke was higher for women than for men (hazard ratio 3.1, 95% confidence interval 1.4 to 6.9; p = 0.007). There was no difference in overall survival between men and women. Conclusion The risk of stroke after LVAD varies based on gender, with a higher risk in female patients. More research is needed to fully understand these differences, and whether device management strategies should be tailored based on gender.