Effectiveness of Implantable Cardioverter-Defibrillators for the Primary Prevention of Sudden Cardiac Death in Women With Advanced Heart Failure

Ghanbari, Hamid; Dalloul, Ghassan; Hasan, Reema; Daccarett, Marcos; Saba, Souheil; David, Shukri; Machado, Christian

doi:10.1001/archinternmed.2009.255

Cited by 202 publications

(127 citation statements)

References 47 publications

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“…Similar findings were reported in 2 other meta-analyses. 2,3 Although the results of these studies require prospective validation, our analysis suggests that women are less likely to die suddenly and therefore have less opportunity to benefit from an ICD.…”

Section: Discussionmentioning

confidence: 88%

Important Differences in Mode of Death Between Men and Women With Heart Failure Who Would Qualify for a Primary Prevention Implantable Cardioverter-Defibrillator

et al. 2012

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Background— Whether sex differences in implantable cardioverter-defibrillator (ICD) benefit exist remains unanswered. We evaluated sex differences in mode of death among a large cohort of ambulatory heart failure patients who meet criteria for a primary prevention ICD. Methods and Results— Patients from 5 trials or registries were included if they met American College of Cardiology/American Heart Association/Heart Rhythm Society guideline criteria for implantation of a primary prevention ICD. We investigated the potential sex differences in total deaths and total deaths by mode of death. The relationship between the estimated total mortality and mode of death by percentage of total mortality was also analyzed by sex. The Seattle Heart Failure Model was used to estimate total mortality in this analysis. A total of 8337 patients (1685 [20%] women) met inclusion criteria. One-year mortality was 10.8±0.3%. In women, the age-adjusted all-cause mortality was 24% lower (hazard ratio [HR], 0.76; confidence interval [CI], 0.68–0.85; P <0.0001), the risk of sudden death was 32% lower (HR, 0.68; CI, 0.58–0.68; P <0.0001), but no significant difference in pump failure death was observed. Throughout a range of total mortality risk, women had a 20% lower all-cause mortality (HR, 0.80; CI, 0.71–0.89; P <0.001) and 30% fewer deaths that were sudden (HR, 0.70; CI, 0.59–0.82; P <0.0001) compared with men. Conclusions— Women with heart failure have a lower mortality than men, and fewer of those deaths are sudden throughout a spectrum of all-cause mortality risk. These data provide a plausible reason for and thus support the possibility that sex differences in ICD benefit may exist.

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Section: Discussionmentioning

confidence: 88%

Important Differences in Mode of Death Between Men and Women With Heart Failure Who Would Qualify for a Primary Prevention Implantable Cardioverter-Defibrillator

et al. 2012

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“…In a meta-analysis of 5 major randomized primary prevention trials comparing medical therapy with ICD therapy, Ghanbari et al 72 reported that ICD did not confer a survival benefit for women (HR, 1.01; 95% CI, 0.76-1.33; P=0.95). In contrast, a 22% reduction in mortality was observed for men receiving ICD therapy (HR, 0.78; 95% CI, 0.70-0.87; P<0.001).…”

Section: Primary and Secondary Prevention Of Scdmentioning

confidence: 99%

Atrial Fibrillation and Ventricular Arrhythmias

Gillis

2017

Circulation

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ABSRACT: Sex-specific differences in the epidemiology, pathophysiology, clinical presentation, clinical treatment, and clinical outcomes of atrial fibrillation (AF), sustained ventricular arrhythmias, and sudden cardiac death are recognized. Sex hormones cause differences in cardiac electrophysiological parameters between men and women that may affect the risk for arrhythmias. The incidence and prevalence of AF is lower in women than in men. However, because women live longer and AF prevalence increases with age, the absolute number of women with AF exceeds that of men. Women with AF are more symptomatic, present with more atypical symptoms, and report worse quality of life in comparison with men. Female sex is an independent risk factor for death or stroke attributable to AF. Oral anticoagulation therapy for stroke prevention has similar efficacy for men and women, but older women treated with warfarin have a higher residual risk of stroke in comparison with men. Women with AF are less likely to receive rhythm control antiarrhythmic drug therapy, electric cardioversion, or catheter ablation in comparison with men. The incidence and prevalence of sustained ventricular arrhythmias and sudden cardiac death are lower in women than in men. Women receiving implantable cardioverter defibrillators for primary prevention of sudden cardiac death are less likely to experience sustained ventricular arrhythmias in comparison with men. In contrast, women receiving a cardiac resynchronization therapy implantable cardioverter defibrillator for the treatment of heart failure are more likely to benefit than men. Women are less likely to be referred for implantable cardioverter defibrillator therapy despite current guideline recommendations. Women are more likely to experience a significant complication related to implantable cardioverter defibrillator implantation in comparison with men. Whether sex differences in treatment decisions reflect patient preferences or treatment biases requires further study.

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“…Data from a sample of Medicare beneficiaries who met the criteria for ICD implantation for the primary prevention of SCD revealed that only 8.6/1000 women received an ICD compared with 32.3/1000 men within 1 year of diagnosis. 33 An observational study of more than 13 000 patients admitted with systolic heart failure (LVEF <30%) to hospitals participating in the American Heart Association's Get With the Guidelines-Heart Failure program reported that, among patients eligible for ICD therapy, only 35.4% of them had an ICD or a planned ICD implantation upon discharge. After adjustment for patient characteristics and hospital factors, the adjusted odds of ICD use were 0.73 for African American men, 0.62 for Caucasian women, and 0.56 for African American women, compared with Caucasian men.…”

Section: Sex Differences In Utilization and Response To Implantable Dmentioning

confidence: 99%

Arrhythmias in Women

Curtis

Narasimha

2012

Clinical Cardiology

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There are important gender differences in cardiac electrophysiology that affect the epidemiology, presentation, and prognosis of various arrhythmias. Women have been noted to have higher resting heart rates compared to men. They also have a longer QT interval, which puts them at an increased risk for drug-induced torsades de pointes. Women with atrial fibrillation are at a higher risk of stroke, and they are less likely to receive anticoagulation and ablation procedures compared to men. Women have a lower risk of sudden cardiac death and are less likely to have known coronary artery disease at the time of an event compared to men. Both men and women have been shown to derive an equal survival benefit from implantable cardioverter defibrillators and cardiac resynchronization therapy, although these devices are significantly underutilized in women. Women also appear to have a better response to cardiac resynchronization therapy in terms of reduced numbers of hospitalizations and more robust reverse ventricular remodeling. Further studies are required to elucidate the underlying pathophysiology of these sex differences in cardiac arrhythmias. IntroductionSex differences in cardiac electrophysiology affect the epidemiology, presentation, and prognosis of various arrhythmias. These sex differences can have important clinical and therapeutic implications. Although the exact reason for these differences is not known, the potential mechanisms include differences in cardiac size, structure, and the different ways in which hormones, drugs, and electrolytes affect cardiac ion channels in men and women. The purpose of this review is to provide a synopsis of the important gender differences with respect to arrhythmias and to summarize updates from recent studies.

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Effectiveness of Implantable Cardioverter-Defibrillators for the Primary Prevention of Sudden Cardiac Death in Women With Advanced Heart Failure

Cited by 202 publications

References 47 publications

Important Differences in Mode of Death Between Men and Women With Heart Failure Who Would Qualify for a Primary Prevention Implantable Cardioverter-Defibrillator

Important Differences in Mode of Death Between Men and Women With Heart Failure Who Would Qualify for a Primary Prevention Implantable Cardioverter-Defibrillator

Atrial Fibrillation and Ventricular Arrhythmias

Arrhythmias in Women

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