Improved Outcomes for Women on the Heart Transplant Wait List in the Modern Era

• Women initially listed as status 1A or 1B for heart transplant have a higher risk of removal from the wait list for death or deterioration, even after adjusting for differences in baseline risk factors.
• Even in the modern era, continuous-flow left ventricular assist devices (LVADs) are implanted in women less frequently than in men.
• Adjusting for sex-based differences in clinical factors, including the use of LVAD eliminated the higher risk associated with female sex in the modern era, suggesting that sex-based disparities in wait list outcomes are improving with time.

BackgroundWhether the routine use of continuous-flow left ventricular assist devices (LVAD) has affected gender differences in outcomes for patients listed for heart transplantation (HT) is unclear.Methods and ResultsWe identified 20,468 adults (25% women) listed as status 1A or 1B for HT from 2000 to 2014. Sex differences in removal from the wait list during the first 365 days due to death or deterioration was assessed with the use of Kaplan-Meier survival analysis. Patients were stratified according to listing before (era 1) or after (era 2) Food and Drug Administration approval of the Heartmate II LVAD on April 22, 2008. Freedom from death or deterioration on the wait list was higher for men than for women (70% vs 64%; P < .001). After adjusting for risk factors, women had a higher risk of removal from the wait list at 365 days during both era 1 (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.10–1.36; P < .001) and era 2 (HR 1.15, 95% CI 1.01–1.31; P = .029). Further adjustment for LVAD use eliminated the higher risk for women in era 2 (HR 1.14, 95% CI 0.99–1.29; P = .053) and not in era 1 (HR 1.22, 95% CI 1.10–1.36; P < .001).ConclusionsThe higher risk for death or deterioration in women waiting for HT has improved in the modern era.