Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA.
Department of Cardiology, Jersey Shore University Medical Center, Neptune City, New Jersey, USA.
Catheter Cardiovasc Interv. 2024 Feb;103(2):376-381. doi: 10.1002/ccd.30892. Epub 2023 Oct 23.
Heart failure (HF) continues to be a significant public health issue, posing a heightened risk of morbidity and mortality for both genders. Despite the widespread use of left ventricular assist device (LVAD), the influence of gender differences on clinical outcomes following implantation remains unclear.
We investigated the impact of gender differences on readmission rates and other outcomes following LVAD implantation in patients admitted with advanced HF.
We conducted a retrospective study of patients who underwent LVAD implantation for advanced HF between 2014 and 2020, using the Nationwide Readmissions Database. Our study cohort was divided into male and female patients. The primary outcome was 30-day readmission (30-dr), while secondary outcomes were inpatient mortality, length of stay (LOS), procedural complication rates, and periadmission rates. Multivariate linear, Cox, and logistic regression analyses were performed.
During the study period, 11,492 patients with advanced HF who had LVAD placement were identified. Of these, 22% (n = 2532) were females and 78% (n = 8960) were males. The mean age was 53.9 ± 10.8 years for females and 56.3 ± 10.5 years for males (adjusted Wald test, p < 0.01). Readmissions were higher in females (21% vs. 17%, p = 0.02) when compared to males. Cox regression analysis showed higher readmission events (hazard ratio: 1.24, 95% confidence interval: 1.01-1.52, p = 0.03) in females when compared to males. Inpatient mortality, LOS, and most procedural complication rates were not statistically significantly different between the two groups (p > 0.05, all).
Women experienced higher readmission rates and were more likely to be readmitted multiple times after LVAD implantation when compared to their male counterparts. However, there were no significant sex-based differences in inpatient mortality, LOS, and nearly all procedural complication rates. These findings suggest that female patients may require closer monitoring and targeted interventions to reduce readmission rates.
心力衰竭（HF）仍然是一个重大的公共卫生问题，无论男女，发病率和死亡率都显著升高。尽管左心室辅助装置（LVAD）的应用广泛，但在植入后，性别差异对临床结局的影响仍不清楚。
我们研究了性别差异对因晚期心力衰竭而接受 LVAD 植入的患者的再入院率和其他结局的影响。
我们使用全国再入院数据库，对 2014 年至 2020 年间接受 LVAD 植入术治疗晚期 HF 的患者进行了回顾性研究。我们的研究队列分为男性和女性患者。主要结局为 30 天再入院（30-dr），次要结局为住院死亡率、住院时间（LOS）、程序并发症发生率和入院前率。进行了多变量线性、Cox 和逻辑回归分析。
在研究期间，确定了 11492 例接受 LVAD 植入的晚期 HF 患者。其中，22%（n=2532）为女性，78%（n=8960）为男性。女性的平均年龄为 53.9±10.8 岁，男性为 56.3±10.5 岁（调整 Wald 检验，p<0.01）。与男性相比，女性的再入院率更高（21%比 17%，p=0.02）。Cox 回归分析显示，与男性相比，女性再入院事件的发生率更高（风险比：1.24，95%置信区间：1.01-1.52，p=0.03）。两组间住院死亡率、LOS 和大多数程序并发症发生率无统计学差异（p>0.05，均）。
与男性相比，女性在接受 LVAD 植入后再入院率更高，且更有可能多次再入院。然而，在住院死亡率、LOS 和几乎所有程序并发症发生率方面，没有明显的性别差异。这些发现表明，女性患者可能需要更密切的监测和有针对性的干预措施，以降低再入院率。
