February 26th, 2015
Exploring Sex Differences in the Use of Mechanical Circulatory Support for Advanced Heart Failure
The CardioExchange Editors interviewed Jennifer L. Cook, lead author of an article in Circulation: Cardiovascular Quality and Outcomes from the genVAD Working Group. The article reviews the evidence on why fewer women than men receive mechanical circulatory support (with a ventricular assist device) for advanced heart failure.
Editors: Why are there differences in utilization of mechanical support between men and women?
Cook: Although the incidence of heart failure is similar in men and women, women are more likely to die from it. Nevertheless, a common misperception persists that men are at greater risk. Although advanced therapies such as mechanical support are as effective in women as in men, women are less likely to receive mechanical support. In clinical trials investigating mechanical support as a bridge to transplantation, fewer than 30% of patients were women. In trials investigating mechanical support for patients ineligible for heart transplantation, even fewer were women: <20%.
Editors: What can we do to address these differences?
Cook: It has been shown that women with heart failure are more likely to remain under the care of a primary physician instead of being referred for specialized cardiovascular care. The explanation for this pattern is not understood. It is important to raise awareness and emphasize the high risk for heart failure–related mortality among women. Once referred for specialized heart failure care, women face barriers to mechanical support. Investigation among mechanical support patients has not been done; however, in the heart transplant population, it is known that women frequently opt out of advanced surgical therapy. This warrants investigation, as unmet educational and psychosocial needs are likely to exist in this population.
Editors: Tell us about the role of the genVAD group and its long-term goals.
Cook: The genVAD working group came together because several of us believed that questions regarding sex-specific differences in treating patients with advanced heart failure have yet to be answered. The group includes investigators who represent diverse perspectives in advanced heart failure and mechanical support has the following goals: to raise awareness of the high-risk profile in women, to address barriers to consideration of mechanical support, to advance scientific knowledge about sex differences, and ultimately to improve access to care and clinical outcomes among women.
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Share your perspective on Dr. Cook’s discussion of the work of the genVAD group.