Gender Bias in LVAD Referral Patterns - A Survey of Patients and Providers

Purpose LVADs offer survival benefit to pts with advanced heart failure (HF). Though HF rates are higher in women, female (F) pts remain underrepresented as LVAD recipients and participants in clinical trials. We aimed to evaluate the role of gender bias in referral patterns for LVAD. Methods Separate questionnaires were administered to F and male (M) LVAD pts and to cardiologists. The pt questionnaire consisted of 7 questions about satisfaction with LVAD and perception of gender bias in LVAD referral. The physician questionnaire tested knowledge of gender specific outcomes after LVAD and individual referral practices. The Edmonton Symptom Assessment Score (ESAS) was measured in pts prior to LVAD to assess levels of pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath, with higher scores indicating greater symptom burden. Results 28 pts participated; 14 (50%) were F. Indication was bridge to transplant in 18 pts (64.3%), including 9 F and 9 M. Average time on support was 19.1±2.9 mo, which was similar between F and M. Average ESAS prior to LVAD was 16.5±2.9; 19.3±4.0 in F and 13.9±4.1 in M. The majority of F and M did not perceive a gender bias in LVAD referral. However, F overall were less satisfied with the LVAD and were less likely to recommend the procedure to others, with 64.3% reporting that they would recommend LVAD compared to 92.9% of M. F expressed greater improvement in relationships with their partners after LVAD: 36% vs. 25% respectively. Of the 7 cardiologists who participated in the study, none identified a gender difference in eligibility for or mortality after LVAD. However, more cardiologists were “unsure” about complication rates in F than in M (Fig). Conclusion Patients and cardiologists alike do not identify a gender bias in referral patterns for LVADs. However, gender differences exist in patient satisfaction with LVAD therapy and in physicians’ knowledge of complication rates after LVADs. Future studies should continue to explore gender differences in LVAD therapy.