Women Have More Early Right Heart Failure But No Increase in Later Right Heart Failure After LVAD Implantation: An INTERMACS Analysis

Introduction Despite an increase in the prevalence of advanced heart failure in women, women are less likely to be treated with durable LVAD therapy and may have increased risk of early post LVAD complications. Previous studies have shown that women have increased risk of post LVAD early right heart failure (ERHF) and need for RVAD support. However, it is unclear if women have a higher risk of developing late right heart failure (LRHF). Hypothesis We sought to investigate whether women are more likely to develop ERHF and LRHF post LVAD implantation and further assess whether sex modifies the relationship between ERHF and long term outcomes. Methods We included 12,923 patients from the INTERMACS registry who received primary continuous-flow (CF)-LVAD between 2012-2017. ERHF was defined as death due to RHF by one month, need for RVAD by one month, or need for inotropes for more than 2 weeks. Cox regression was used to model the relationship of sex and both ERHF and LRHF, adjusting for the competing risk of death and receiving a heart transplantation using Fine-Gray methods. The interaction of sex and the relationship of ERHF and LRHF as well as sex and the relationship of ERHF and mortality were evaluated. Results Of those included, 22% were women and 78% were men. Women were younger (55 vs 58 y, p Conclusion Among those in the INTERMACS registry receiving primary CF-LVAD, females had a higher risk of ERHF but not LRHF. Further studies are needed to investigate reasons for the observed discrepancies.