Race by Gender after Mechanical Circulatory Support: Impact on Survival and Adverse Events

Purpose Survival and the relative impact of adverse events after mechanical circulatory support may be different amongst white males (WM), black males (BM), white females (WF) and black females (BF). Methods Patients implanted with the HeartWareTM HVADTM System in the BTT/CAP, ENDURANCE and ENDURANCE Supplemental trials were assessed. Baseline characteristics, survival and adverse events were investigated and compared between WM, BM, WF and BF. Results There were 947 patients included: 60% WM, 16% BM, 15% WF and 9% BF. There were no differences in INTERMACS profile at implant. WM were more likely to be older, with more ischemic risk factors (smoking 70.0%, diabetes 46.7%, carotid disease 15.8%, ischemic HF 64.0%, MI 51.6%, CABG 32.9%). BM had a higher mean body mass index (29.2 kg/m2) and renal insufficiency (mean 1.5 mg/dL), while WF were least likely to be hypertensive (48.2%). Implant as DT was highest in WM 66.3% and lowest in WF 51.1%. According to 4-year adverse event rates per patient year (Figure 1A), WM had highest rates of gastrointestinal bleeds, ischemic stroke, and pump thrombosis, but lowest risk of right heart failure. WF had the lowest risk for driveline infection. Mean duration of support (months) was longest in BF 31.7 compared to WM 24.8, BM 29.4, and WF 25.8, p=0.007. However, BF had the best survival at two years and overall; WM had the worst survival. (Figure 1B) Conclusion In a large cohort of HVAD recipients, white men had the highest rates of gastrointestinal bleeding, pump thrombus, ischemic stroke and the worst survival. Black women had a significantly longer duration of support, but the highest survival, particularly in the first two years post-implant.