心力衰竭治疗中性别差异的资格评估。
Sex differences in eligibility for advanced heart failure therapies.
机构信息
Division of Cardiology, Emory University, Atlanta, Georgia.
Emory Healthcare, Emory Transplant Center, Atlanta, Georgia.
出版信息
Clin Transplant. 2020 May;34(5):e13839. doi: 10.1111/ctr.13839. Epub 2020 Mar 16.
OBJECTIVES
We investigated sex-based differences in eligibility for and outcomes after receipt of advanced heart failure (HF) therapies.
BACKGROUND
Although women are more likely to die from HF than men, registry data suggest that women are less likely to receive heart transplant (HT) or left ventricular assist device (LVAD) for largely unknown reasons.
METHODS
We performed a single-center retrospective cohort study of patients evaluated for advanced HF therapies from 2012 to 2016. Logistic regression was used to determine the association of sex with eligibility for HT/LVAD. Competing risks and Kaplan-Meier analysis were used to examine survival.
RESULTS
Of 569 patients (31% women) evaluated, 223 (39.2%) were listed for HT and 81 (14.2%) received destination (DT) LVAD. Women were less likely to be listed for HT (adjusted odds ratio [OR] 0.36, 95% confidence interval [CI] 0.21-0.61; P < .0001), based on allosensitization (P < .0001) and obesity (P = .02). Women were more likely to receive DT LVAD (adjusted OR 2.29, 95% CI 1.23-4.29; P = .01). Survival was similar between men and women regardless of whether they received HT and DT LVAD or were ineligible for therapy.
CONCLUSION
Women are less likely to be HT candidates, but more likely to receive DT LVAD.
目的
我们研究了接受晚期心力衰竭（HF）治疗的患者中，基于性别的入选资格和治疗结局差异。
背景
尽管女性死于 HF 的可能性高于男性，但登记数据表明，女性接受心脏移植（HT）或左心室辅助装置（LVAD）的可能性较低，其原因主要未知。
方法
我们对 2012 年至 2016 年期间接受晚期 HF 治疗评估的患者进行了单中心回顾性队列研究。采用逻辑回归来确定性别与 HT/LVAD 入选资格的关系。使用竞争风险和 Kaplan-Meier 分析来检查生存情况。
结果
在评估的 569 名患者中（31%为女性），有 223 名（39.2%）被列入 HT 名单，81 名（14.2%）接受了目的地（DT）LVAD。女性被列入 HT 名单的可能性较低（调整后的优势比[OR]0.36，95%置信区间[CI]0.21-0.61；P<0.0001），原因是同种异体致敏（P<0.0001）和肥胖（P=0.02）。女性更有可能接受 DT LVAD（调整后的 OR 2.29，95%CI 1.23-4.29；P=0.01）。无论男性和女性是否接受 HT 和 DT LVAD，或是否不符合治疗条件，其生存情况均相似。
结论
女性成为 HT 候选者的可能性较低，但更有可能接受 DT LVAD。
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