Gender Disparity in the Use of Cardiac Resynchronization Therapy in the United States

Alaeddini, Jamshid; Wood, Mark A.; Amin, Mitesh S.; Ellenbogen, Kenneth A.

doi:10.1111/j.1540-8159.2008.01016.x

Cited by 52 publications

(45 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, females were found to be less likely to receive CA for AF than men despite higher number of AF hospitalizations. The causality of the same is unknown but our results were similar to previous studies on cardiac intervention such as use of Cardiac Resynchronization Therapy15 and treatment of non‐ST‐segment elevation acute coronary syndromes 16…”

Section: Discussionsupporting

confidence: 86%

Causes and Predictors of Readmission in Patients With Atrial Fibrillation Undergoing Catheter Ablation: A National Population‐Based Cohort Study

Arora

Lahewala

Tripathi

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundReducing readmission after catheter ablation (CA) in atrial fibrillation (AF) is important.Methods and ResultsWe utilized National Readmission Data (NRD) 2010–2014. AF was identified by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD‐9‐CM) diagnostic code 427.31 in the primary field, while first CA of AF was identified via ICD‐9‐procedure code 37.34. Any admission within 30 or 90 days of index admission was considered a readmission. Cox proportional hazard regression was used to adjust for confounders. The primary outcomes were 30‐ and 90‐day readmissions and the secondary outcome was AF recurrence. In total, 1 128 372 patients with AF were identified from January 1, 2010 to September 30, 2014. Of which 37 360 (3.3%) underwent CA. Patients aged ≥65 years and female sex were less likely to receive CA for AF. Overall, 10.9% and 16.5% of CA patients were readmitted within 30 and 90 days post‐CA, respectively. Most common causes of readmissions were arrhythmia (AF, atrial flutter), heart failure, pulmonary causes (pneumonia, chronic obstructive pulmonary disease) and bleeding complications (gastrointestinal bleed, intracranial hemorrhage). Patients with diabetes mellitus, heart failure, coronary artery disease (CAD), chronic pulmonary and kidney disease, prior stroke/transient ischemic attack (TIA), female sex, length of stay ≥2 and disposition to the facility were prone to higher 30‐ and 90‐day readmissions post‐CA. Predictors of increase in AF recurrence post‐CA were female sex, diabetes mellitus, chronic pulmonary disease, and length of stay ≥2. Trends of 90‐day readmission and AF recurrence were found to improve over the study period.ConclusionsWe identified several demographic and clinical factors associated with the use of CA in AF, and short‐term outcomes of the same, which could potentially help in the patient selection and improve outcomes.

show abstract

Section: Discussionsupporting

confidence: 86%

Causes and Predictors of Readmission in Patients With Atrial Fibrillation Undergoing Catheter Ablation: A National Population‐Based Cohort Study

Arora

Lahewala

Tripathi

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…Leyva et al 38 studied long-term clinical outcomes after CRT implantation in 550 patients, of which 122 (22 %) were women. A Cox proportional hazards analysis showed that women had better survival from death due to any cause as well as cardiovascular death.…”

Section: Sex Disparities In Cardiac Resynchronisation Therapy Utilisamentioning

confidence: 99%

Sex Differences in Utilisation and Response to Implantable Device Therapy

Narasimha¹,

Curtis²

2015

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

Implantable cardiac devices such as implantable cardioverterdefibrillators (ICDs) and cardiac resynchronisation therapy (CRT) devices lead to improved survival and better clinical outcomes in appropriately selected patients with heart failure (HF) with a reduced ejection fraction (EF). Although there are significant sex differences in the aetiology, pathophysiology and clinical course of HF, clinical practice guidelines for cardiac device therapy are not sex-specific and are based on clinical trials where the majority of patients enrolled were men. In this review, we explore sex differences in clinical outcomes and utilisation of ICDs and CRT and explore the reasons for these disparities. Implantable Cardioverter-DefibrillatorsThe annual incidence of sudden cardiac death (SCD) in the US is estimated to be 300,000 to 450,000.1 A major risk factor for SCD is HF with reduced EF. There have been several large randomised controlled studies that have demonstrated a mortality benefit from ICDs in eligible patients for both primary and secondary prevention of SCD. However, under-representation of women in these trials has made it somewhat difficult to determine the sex-specific survival benefit of ICD therapy. Evidence for the Use of ICD Therapy for Primary and Secondary Prevention of SCD Sex Differences in Outcomes with ICD Therapy Sex Differences in ICD Therapy for Secondary Prevention of SCDCurtis et al. 6 analysed a 5 % national sample of patients from the US Centers for Medicare & Medicaid Services eligible for ICD therapy and found that, in the secondary prevention ICD cohort, there was a statistically significant mortality benefit for both sexes even after adjustment for other factors. Sex Differences in Primary Prevention ICDsIn the MUSTT trial, 3 a total of 301 women were enrolled, and they constituted 10 % (68) of the randomised patients and 16 % (233) of those followed in the registry. Overall, there was no statistically significant difference in mortality between men and women in the electrophysiology (EP)-guided therapy group (21 % versus 32 %; p=0.13) or in the registry (20 % versus 27 %; p=0.15). However, there was a trend towards increased mortality in women, although the trial did not have sufficient power to detect gender differences due to the small number of women enrolled.In MADIT-II, 1,232 patients with ischaemic cardiomyopathy were enrolled of which 192 (16 %) were women. 4 Patients received ICDs versus standard medical therapy, with a total of 119 women receiving ICD therapy. Women were noted to have more advanced HF, as well as AbstractMultiple studies have demonstrated that implantable cardioverter-defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) provide significant mortality and morbidity benefits to eligible patients irrespective of gender. However, female patients are less likely to receive this life-saving therapy and are significantly under-represented in cardiac device trials. Various performance improvement programmes have proved that this gender disparity can be reduce...

show abstract

“…Однако механизмы лучшей эффективности СРТ у жен-щин до конца не ясны. Это связано с небольшим коли-чеством женщин, включенных в исследования по СРТ -около 20 % [8,[12][13][14][15]. Исследования COMPANION, CARE-HF не подтвердили гендерных различий эффек-тивности СРТ [16,17].…”

Section: Discussionunclassified

Biochemical aspects of gender differences in response to cardiac resynchronization therapy

Enina¹,

Кузнецов²,

Солдатова³

et al. 2017

RHJ

View full text Add to dashboard Cite

Gender Disparity in the Use of Cardiac Resynchronization Therapy in the United States

Abstract: Our data clearly demonstrate a significant gender disparity in utilization of CRT devices. Further studies are needed to find possible reasons behind this disparity.

Cited by 52 publications

References 15 publications

Causes and Predictors of Readmission in Patients With Atrial Fibrillation Undergoing Catheter Ablation: A National Population‐Based Cohort Study

Causes and Predictors of Readmission in Patients With Atrial Fibrillation Undergoing Catheter Ablation: A National Population‐Based Cohort Study

Sex Differences in Utilisation and Response to Implantable Device Therapy

Biochemical aspects of gender differences in response to cardiac resynchronization therapy

Contact Info

Product

Resources

About