Stroke incidence, sociodemographic disparities, and temporal trends in LVAD-related hospitalizations in the United States: an analysis of the nationwide inpatient sample, 2016–2021

Background

Stroke remains a significant complication of left ventricular assist device (LVAD) therapy, contributing to increased morbidity, mortality, and healthcare costs. The coexistence of stroke in patients undergoing LVAD implantation complicates management, particularly in vulnerable subgroups.

Purpose

Given the racial and socioeconomic diversity in the United States, our study aimed to assess sociodemographic disparities and temporal trends in stroke-related outcomes among patients hospitalized with LVADs.

Methods

LVAD-related hospitalizations were identified using ICD-10 procedure codes for open and external LVAD implantation from the Nationwide Inpatient Sample (NIS) between 2016 and 2021. Stroke events—including ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage—were captured using ICD-10-CM codes. Patient demographics, hospital characteristics, and comorbidities were described using weighted proportions. The association between stroke and outcomes including in-hospital mortality, length of stay (LOS), and total charges (TOTCHG) was evaluated using multivariable regression models adjusted for age, sex, race, ZIP income quartile, and hospital characteristics. Temporal trends were assessed with year modeled as a continuous variable.

Results

Among an estimated 21,130 adult LVAD hospitalizations, stroke was reported in 7.1% of cases. The mean age of stroke patients was 57.2 years vs. 55.0 in those without stroke. Stroke incidence was higher in open LVADs (7.2%) compared to external LVADs (2.7%). Most stroke patients were White (58.7%), followed by Black (21.5%) and Hispanic (10.1%) patients. Despite this, the odds of stroke were significantly higher among minority groups after adjustment.

Female patients had 1.3 times higher odds of mortality compared to males (p = 0.021). Adjusted analyses showed stroke was associated with significantly worse outcomes: an increase in LOS by 17.4 days (p < 0.001), an increase in hospitalization costs by $485,000 (p < 0.001), and a 5.6-fold higher odds of in-hospital mortality (p < 0.001). Although stroke incidence rose marginally year to year, the trend was not statistically significant (p = 0.362), and neither was the trend in stroke-associated mortality (p = 0.269).

Conclusions

Stroke affects over 1 in 14 LVAD hospitalizations and is associated with disproportionately poor clinical and economic outcomes. Racial and sex-based disparities were observed in stroke incidence and outcomes, highlighting the need for more targeted stroke prevention and post-implant care strategies. Although stroke incidence did not change significantly over time, the persistent burden underscores the importance of continued surveillance and equitable access to advanced heart failure care.