Sex Differences in Left Ventricular Assist Device-related Emergency Department Visits in the United States

Introduction Studies regarding sex differences in patients with LVADs have demonstrated variable characteristics and outcomes in terms of frequency of adverse events and mortality by sex. There are limited data regarding differences in LVAD-related emergency department (ED) visits between women and men. Hypothesis Comorbidity burden and clinical outcomes of LVAD patients vary by sex. Methods We performed a retrospective analysis of 44,042 LVAD-related ED encounters from the 2010-2017 Nationwide Emergency Department Sample (NEDS). ICD-9/10 codes were used to identify patients with LVADs and their associated primary and comorbidity diagnoses. Demographics, clinical characteristics, and outcomes (death, hospital admission, and rates of LVAD-related procedures) were compared via Chi-square tests. Results Women comprised 26% (n=11654) of LVAD-related ED visits. Compared to men, women were younger (58.1 years [IQR 46.59, 67.13] vs. 61.5 [IQR 51.66, 69.31]; p 0.05). Women underwent endoscopy less frequently than men (5.1% vs. 6.8%, p = 0.006), but there were no differences in blood transfusion, catheterization, device exchange, and heart transplantation (p for all ≥ 0.05). Despite being less likely than men to be admitted to the hospital (61.6% vs. 67.6%, p Conclusions Compared to men, the comorbidity profiles and clinical outcomes of women with LVADs who seek ED evaluation significantly differ. Future analyses will further explore the disparity in hospital admission by sex despite similar mortality rates. Understanding these sex differences among VAD patients is a critical step in the effort to improve long-term outcomes. Figure 1. Comorbidities (A), Primary Diagnosis (B), ED or Hospital Procedures Performed (C), and Outcomes (D) of LVAD-related ED Encounters by Sex