Age as a Surrogate for Hormonal Status and Outcomes of Women on Left Ventricular Assist Device Support—An EUROMACS Analysis

Background: 

Sex differences in outcomes of patients on left ventricular assist devices (LVAD) have been reported with conflicting results. Female hormonal status affects vascular integrity and cardiac remodeling. As menopausal transition is complex and individually variable, we used age as a surrogate for hormonal status and compared outcomes in younger and older women with age-matched men.

Methods: 

Data from 5.275 patients from the EUROMACS registry were screened. Women < 40 years (31.0 ± 6.3 years, n = 142, surrogate premenopausal) and > 60 years (65.5 ± 3.7 years, n = 256, surrogate postmenopausal) were included, while women aged 40–60 years were excluded to avoid misclassification during the perimenopausal transition. For comparison, 2138 age-matched males were included. The primary outcome was survival, with transplantation and weaning as competing risks. Secondary outcomes were defined as adverse events and length of intensive-care-unit stay. 

Results: 

Young women were more likely to present in cardiogenic shock before LVAD implantation (INTERMACS level1-2: 65.6% vs. 45.4%, p = 0.022). Within four years, young women had higher rates of weaning, transplantation and survival (weaning:sHR 1.58, 95% CI 0.73–3.4, p = 0.248; transplant: sHR2.93, 95% CI 1.86–4.61, p < 0.001; survival:sHR 2.25, 95% CI 1.48–3.41; p = 0.001). Major adverse events were more frequent in older women (bleeding: RR2.53, 95%-CI 1.7–3.8, p < 0.001; infection: RR1.43, 95% CI 1.2–1.8, p < 0.001). Comparable differences were observed in age-matched males. 

Conclusions: 

Outcomes differed between age groups, but not consistently between sexes within the same age group, suggesting age rather than sex or menopausal status driving outcome differences. These descriptive findings support equitable consideration of LVAD therapy irrespective of sex.