Stroke Risk and Mortality in Patients With Ventricular Assist Devices

Abstract

Background and Purpose Ventricular assist devices (VADs) have advanced the management of end-stage heart failure. However, these devices are associated with hemorrhagic and thrombotic complications, including stroke. We assessed the incidence, risk factors, and outcomes of ischemic and hemorrhagic stroke after VAD placement. Methods Using administrative claims data from acute care hospitals in California, Florida, and New York from 2005–2013, we identified patients who underwent VAD placement, defined by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 37.66. Ischemic and hemorrhagic strokes were identified by previously validated coding algorithms. We used survival statistics to determine incidence rates and Cox proportional hazard analyses to examine associations. Results Among 1,813 patients, we identified 201 ischemic strokes and 116 hemorrhagic strokes during 3.4 (±2.0) years of follow-up after implantation of a VAD. The incidence of stroke was 8.7% per year (95% confidence interval [CI], 7.7–9.7%). The annual incidence of ischemic stroke (5.5%; 95% CI, 4.8–6.4%) was nearly double that of hemorrhagic stroke (3.1%; 95% CI, 2.6–3.8%). Women faced a higher hazard of stroke than men (hazard ratio [HR], 1.6; 95% CI, 1.2–2.1), particularly hemorrhagic stroke (HR, 2.2; 95% CI, 1.4–3.4). Stroke was strongly associated with subsequent in-hospital mortality (HR, 6.1; 95% CI, 4.6–7.9). Conclusions The incidence of stroke after VAD implantation was 8.7% per year, and incident stroke was strongly associated with subsequent in-hospital mortality. Notably, ischemic stroke occurred at nearly twice the rate of hemorrhagic stroke. Women appeared to face a higher risk for hemorrhagic stroke than men.

Intermediate‐Term Risk of Stroke Following Cardiac Procedures in a Nationally Representative Data Set

“…[8][9][10] Using administrative claims data from New York, California, and Florida, there was an 8.7% annual risk of stroke following LVAD (5.5% ischemic, 3.1% hemorrhagic). 20 This annual incidence of stroke was similar in another single-center study. 9 While intermediate risk (up to 90 days) and annual risk are not directly comparable, the current study also suggests that in the intermediate risk period, patients were readmitted more commonly with ischemic than hemorrhagic stroke after LVAD.…”

“…Most past studies compare outcomes with different devices within single centers 8, 9, 10. Using administrative claims data from New York, California, and Florida, there was an 8.7% annual risk of stroke following LVAD (5.5% ischemic, 3.1% hemorrhagic) 20. This annual incidence of stroke was similar in another single‐center study 9.…”

Cardioembolic Stroke: Mechanisms and Therapeutics

“…Ischemic stroke risk is $4 to 9% per year and 2 to 3 times higher in patients with prior stroke. [73][74][75] Heart failure is also a known risk factor for the development of AF, making these two clinical entities synergistic in their ability to potentiate cardioembolic stroke.…”

Reducing regional flow stasis and improving intraventricular hemodynamics with a tipless inflow cannula design: An in vitro flow visualization study using the EVAHEART LVAD

“…Reduction of thromboembolic complications is critical for mechanical circulatory support, as stroke rates remain high for rotary blood pumps with a 8.7% incidence after implantation of an left ventricular assist device (LVAD). 1 In addition to the high incidence of stroke events, there is a high risk associated with stroke. In the third quarter of 2017, INTERMACS identified neurological dysfunction as the primary cause of death in 18.8% of reported deaths.…”