Background: Ventricular assist devices (VADs) have revolutionized the management of end-stage heart failure. However, these devices are associated with many complications, including stroke.
Hypothesis: We sought to determine the risk and risk factors for stroke after VAD placement and to assess the hypothesis that stroke is associated with increased mortality after VAD placement.
Methods: From administrative claims data on all discharges from nonfederal acute care hospitals in California, Florida, and New York from 2005-2012, we used International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 37.66 to identify patients who underwent VAD placement. Patients were included regardless of whether they underwent VAD placement as destination therapy or as bridge to transplant. Ischemic and hemorrhagic strokes were identified by validated coding algorithms. Kaplan-Meier statistics were used to calculate cumulative rates. Cox proportional hazard analyses were used to identify risk factors for stroke in patients with VADs and to evaluate the association between stroke (modeled as a time-varying covariate) and mortality.
Results: We had 3.0 (±1.7) years of follow-up data on 1,398 patients after implantation of a VAD. The mean age of the patients was 55.4 years (±13.2), and patients were predominantly male. A total of 227 strokes were identified: 147 ischemic and 79 hemorrhagic. The cumulative stroke rate was 24.3% (95% confidence interval [CI], 21.3-27.7%). After adjustment for age, race, insurance status, and comorbidities, women had a higher hazard of stroke than men (hazard ratio [HR], 1.7; 95% CI, 1.2-2.3), particularly hemorrhagic stroke (HR, 2.6; 95% CI, 1.5-4.3). Stroke was strongly associated with subsequent mortality (HR, 4.1; 95% CI, 3.3-5.1).
Conclusion: Stroke is common in patients after VAD placement and is strongly associated with mortality in this vulnerable population. Women appear to be at higher stroke risk than men, particularly for hemorrhagic stroke.