Sex-Based Differences in Management and Outcomes of Patients Admitted or Transferred to Advanced Therapy Centers for Heart Failure

Background: Heart failure (HF) is a major public health challenge. Management at or transfer to advanced therapy centers (ATCs) is linked to greater procedural use and better outcomes for HF, however there is little data on the impact of patient sex on access to ATCs and transfer patterns. We evaluated sex-based differences in HF management and outcomes during admissions across center types and transfer status. Method: Adult HF admissions were identified in the 2016–19 Nationwide Readmissions Database. Centers performing ≥1 heart transplant or LVAD were classified as ATCs. Patients were stratified by sex and center type: (A) non-ATC admission, (B) ATC admission, (C) transfer to ATC. Multivariable regression adjusted for comorbidities and HF decompensations. Results: Among 2,872,268 weighted HF admissions (51.3% male), females were older, while males had more HF decompensations (cardiogenic shock, ventricular arrhythmias, mechanical ventilation, AKI). Females comprised only 39.6% of all transfers to ATCs (0.4% vs. 0.6%, OR 0.69, p < 0.001) and had a lower unadjusted mortality (2.6% vs. 2.8%, p < 0.001); however, rates of transfer and mortality were similar between sexes when adjusted for comorbidities and HF decompensations. Female patients were significantly less likely to receive invasive procedures (CRT/ICD, PCI, right heart catheterization, CABG, temporary mechanical support, ECMO, LVAD or heart transplant) across all hospital types and transfers. This disparity in procedural utilization persisted after multivariable adjustment and in sensitivity analysis of patients with severe HF. Conclusions: Females had lower frequency of transfer to ATCs. In-hospital mortality and transfer rates to ATCs were similar across patient sex when adjusted for comorbidities and HF decompensations. Females consistently underwent fewer diagnostic and therapeutic interventions across all center types and transfers.