Wait list mortality higher for female heart transplant candidates

ORLANDO, Fla. — Female heart transplant candidates have a higher risk for 1-year morbidity and mortality while on the transplantation waiting list compared with male candidates, according to a report presented at the Annual Scientific Meeting of the Heart Failure Society of America.

Alanna A. Morris, MD, of Emory University, said the gender discrepancy that emerged in this study may be due to underutilization of implantable cardioverter defibrillators and ventricular assist devices (VADs) in women.

“Our results suggest that more aggressive use of ICDs and VADs might be the key to eliminating wait-list disparities,” Morris said at a presentation.

Alanna A. Morris

The researchers investigated differences in survival rates between men and women with end-stage HF (n=26,872; 23% women) who were listed in the Organ Procurement and Transplantation database for a heart transplant. The primary outcome was removal from the wait list because of death or being deemed too sick for transplantation.

According to results presented, the unadjusted 1-year survival rate was 73% for men and 70% for women (P=.006). After adjustment for age, race/ethnicity, BMI, ABO blood type, diabetes, renal function, pulmonary capillary wedge pressure ≥15 mm Hg, inotropes and support with extracorporeal membrane oxygenation or intra-aortic balloon pump, the researchers found that female gender was linked to a 10% increased risk for removal from the wait list at 1 year due to death or being deemed too sick to transplant. Further adjustment for ICD use reduced the rate of increased risk to 8% (P for trend=.06), and adjustment for an ICD or any kind of VAD “completely eliminated” female gender as a risk factor, Morris said.

“ICDs and VADs were both protective against the primary endpoint,” she said. “We conclude that the higher rate of mortality for females on the wait list may be influenced by lower rates of use of ICDs and VADs based on gender. Prior data have certainly documented significantly lower rates of ICD implantation among women with end-stage HF.”

The median number of days on the wait list was 67 for women vs. 84 for men (P<.001). Women were less likely to have an ICD (55% vs. 64%; P<.001), were less likely to have a VAD (24% vs. 3-30%; P<.001), were younger (52 years vs. 56 years; P<.001), and had a lower pulmonary capillary wedge pressure (20 mm Hg vs. 21 mm Hg; P<.001) and lower creatinine (1.2 mg/dL vs. 1.4 mg/dL; P<.001) compared with men.

In the past decade, the proportion of women on the wait list for heart transplantation has increased by 4.2%, Morris said. – by Erik Swain

For more information:

Morris AA. Abstract #207. Presented at: the Annual Scientific Meeting of the Heart Failure Society of America; Sept. 22-25, 2013; Orlando, Fla.

Disclosure: Morris reports no relevant financial disclosures.