Global and regional prevalence, temporal trends, and projected trends of stroke after left ventricular assist device implantation: a systematic review and meta-analysis of 132,869 patients from 16 countries.

Abstract

Introduction: Stroke after left ventricular assist device (LVAD) implantation is a serious complication in patients receiving LVAD treatment. This study aims to estimate the global and regional prevalence, temporal trends, and projected trends of post-LVAD stroke.

Methods: This study compiled literature on stroke prevalence post-LVAD implantation through PubMed and Web of Science searches. Global and regional prevalence rates were aggregated. Sensitivity analyses, subgroup analyses, meta-regression analyses, and publication bias analyses were also conducted. A smooth spline regression model assessed temporal and projected trends.

Results: Data from 99 studies (132,869 patients) showed a 14.0% (95% CI 12.0-15.0%) stroke prevalence post-LVAD. The highest prevalence was observed in Asia at 18.0% (p < 0.0001), the lowest in North America at 12.0% (p < 0.0001). During the period from 2008 to 2024, the prevalence of stroke after LVAD implantation did not change significantly and remained at a relatively high level, and exploratory projections indicated a declining trend in the next decade (SE = 0.028).

Conclusions: The global prevalence of stroke in LVAD patients is high (14%), but this is likely to decrease over the next decade. These findings can guide clinical practice, optimize patient management, and formulate prevention strategies.

Protocol registration: www.crd.york.ac.uk/prospero identifier is CRD42024617821.