Sex-Based Differences in Left Ventricular Assist Device Utilization: Insights From the Nationwide Inpatient Sample 2004 to 2016.

Journal Article (Journal Article)


Women comprise approximately one-third of the advanced heart failure population but may receive fewer advanced heart failure therapies including left ventricular assist devices (LVADs). During the early pulsatile-flow device era, women had higher post-LVAD mortality and increased complications. However, knowledge about these differences in the continuous-flow device era is limited. Therefore, we sought to explore temporal trends in LVAD utilization and post-LVAD mortality by sex.

Methods and results

Patients with LVAD implantation from 2004 to 2016 were identified using the Nationwide Inpatient Sample. Trends in LVAD utilization and post-LVAD inpatient mortality were compared by sex and device era. Although LVADs are being increasingly utilized for patients with advanced systolic heart failure, women continue to represent a smaller proportion of LVAD recipients-25.8% in 2004 to 21.9% in 2016 (P for trend, 0.91). Women had increased inpatient mortality after LVAD implantation compared with men in the pulsatile-flow era (46.9% versus 31.1%, P <0.0001) but not in the continuous-flow era (13.3% versus 12.1%, P =0.27; P for interaction=0.0002). Inpatient mortality decreased for both sexes over time after LVAD, with a sharp fall in 2008 to 2009. Female sex was independently associated with increased post-LVAD inpatient mortality beyond adjustment for demographics and risk factors during the pulsatile-flow era (odds ratio, 2.13; 95% CI, 1.45-3.10; P <0.0001) but not during the continuous-flow era (1.18; 0.93-1.48; P =0.16).


Although utilization of LVAD therapy increased over time for both sexes, LVAD implantation remains stably lower in women, which may suggest a potential underutilization of this potentially life-saving therapy. Prospective studies are needed to confirm these findings.

Full Text

Duke Authors

Cited Authors

  • Joshi, AA; Lerman, JB; Sajja, AP; Dahiya, G; Gokhale, AV; Dey, AK; Kyvernitakis, A; Halbreiner, MS; Bailey, S; Alpert, CM; Poornima, IG; Murali, S; Benza, RL; Kanwar, M; Raina, A

Published Date

  • September 13, 2019

Published In

Volume / Issue

  • 12 / 9

Start / End Page

  • e006082 -

PubMed ID

  • 31514517

Electronic International Standard Serial Number (EISSN)

  • 1941-3297

International Standard Serial Number (ISSN)

  • 1941-3289

Digital Object Identifier (DOI)

  • 10.1161/circheartfailure.119.006082


  • eng