Gender Disparity in Left Ventricular Assist Device Utilization: Insights from Nationwide Inpatient Sample 2004-2016

Purpose Women comprise over half of the heart failure (HF) population but less commonly receive advanced HF therapies such as left ventricular assist devices (LVAD). Women had higher mortality rates and increased postoperative complications after LVADs during the early pulsatile flow (PF) era and in large registries in the continuous flow (CF) era. Whether these disparities and complication rates persist over time and how they may impact LVAD utilization in women in the CF era is unknown. Methods We utilized the National Inpatient Sample from 2004 to 2016 to identify patients with LVAD placement. Temporal trends in LVAD utilization and post-LVAD inpatient mortality were compared by gender and between PF (before 2009) and CF (2009 and after) era. Results The absolute number of LVAD implants increased for both genders (Fig 1A) over time but the percentage of women overall receiving LVAD remained stably low compared to men over time (less than 30% of total implants; Fig 1B&C). Baseline characteristics including comorbidity profiles, post-LVAD complications and inpatient outcomes are summarized (Table 1). Despite fewer comorbidities, women had higher mortality post LVAD in the PF era (p Conclusion Although overall LVAD implants increased for both genders from 2004 to 2016, LVAD utilization remained comparatively low in women. Disparately increased inpatient mortality in women post-LVAD during the PF era did not remain during the CF era. Prospective studies need to confirm our findings of post-LVAD outcomes between genders. However, our results suggest potential underutilization of LVAD in women with advanced HF in the CF LVAD era.