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

Abstract

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.

Sex-specific outcomes with addition of defibrillation to resynchronisation therapy in patients with heart failure

“…First, women in general have a lower susceptibility to ventricular arrhythmia compared with men18 and are less vulnerable to sudden death than men regardless of the presence of coronary artery disease,19 as our study confirmed. Among patients with heart failure potentially eligible for a primary prevention ICD, women are at lower risk of sudden death compared with men, and fewer of their deaths are sudden throughout a spectrum of all-cause mortality risk, irrespective of heart failure severity 20. Female patients implanted with an ICD/CRT-D experience fewer appropriate ICD therapies than men 8 18 21.…”

Sex Differences in Utilisation and Response to Implantable Device Therapy

“…Men with coronary artery disease (CAD) in whom ICDs have been implanted have more ventricular tachycardia/ventricular fibrillation (VT/VF) events as well as more ICD shocks and electrical storms than women. 14 Lampert et al 15 reviewed the records of 340 men and 59 women with CAD who received an ICD and followed them for 30±22 months. They found that 52 % of the men experienced sustained VT or VF requiring ICD therapy (p<0.01) compared with 34 % of the women.…”

Most Important Outcomes Research Papers on Cardiovascular Disease in Women

“…Improved targeting of ICD therapy may be better obtained by assessment of the underlying cause of systolic dysfunction or assessment of the degree of myocardial fibrosis . 45,46 Trends in Use of ICD Therapy Among Patients Hospitalized for HF: Have the Previously Observed Sex and Racial Disparities Changed Over Time?…”