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

Barra, Sérgio; Providência, Rui; Duehmke, Rudolf; Bovéda, Serge; Marijon, Éloi; Reitan, Christian; Borgquist, Rasmus; Klug, Didier; Defaye, Pascal; Sadoul, Nicolas; Deharo, Jean Claude; Sadien, Iannish; Patel, Kiran; Looi, Khang‐Li; Begley, David; Chow, Anthony; Heuzey, J.-Y. Le; Agarwal, Sharad

doi:10.1136/heartjnl-2016-310677

Cited by 23 publications

(19 citation statements)

References 28 publications

(35 reference statements)

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“…A metaanalysis of 5 major randomized clinical trials of ICD therapy found a mortality benefit in men (HR: 0.78, 95% CI: 0.70-0.87, P < 0.001) but not in women (HR: 1.01, 95% CI: 0.76-1.33, P = 0.95). 31 Barra et al 32 women. This study concluded that the addition of a defibrillator to CRT might convey a benefit only in well-selected male patients.…”

Section: Discussionmentioning

confidence: 99%

“…Barra et al performed an observational multicenter cohort study in 5307 patients with ischemic or nonischemic dilated cardiomyopathy with no history of sustained ventricular arrhythmias. They compared survival in patients with CRT‐D with patients with CRT without defibrillator functionality (CRT–pacemaker [CRT‐P]) and stratified the results by sex.…”

Section: Implantable Cardioverter‐defibrillatorsmentioning

confidence: 99%

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Cardiac implantable electrical devices in women

Elango

Curtis

2018

Clinical Cardiology

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Clinical trials have demonstrated the benefits of cardiac implantable electrical devices, which include pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT), with respect to key clinical outcomes and survival. Women more often require permanent pacing for sick sinus syndrome, whereas atrioventricular block is more common in men. Women appear to have a higher incidence of complications with pacemaker implantation, as well as with ICD and CRT implantation. The indications for ICDs and CRT do not have any distinctions based on sex, and outcomes are comparable in men and women. In fact, women often seem to have better outcomes with CRT compared with men. Despite the demonstrated benefits of these devices, ICDs and CRT are underutilized in women. In this review, we explore sex differences in utilization, outcomes, and complications with pacemakers, ICDs, and CRT.

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Section: Discussionmentioning

confidence: 99%

Section: Implantable Cardioverter‐defibrillatorsmentioning

confidence: 99%

Cardiac implantable electrical devices in women

Elango

Curtis

2018

Clinical Cardiology

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“…More and more, patients want to know what to expect from a treatment option, and are more frequently requesting to be empowered in decisions regarding their management [28]. In patients meeting guideline criteria, when chances of response are low discussion may involve the choice between a CRT-D or a CRT-P device [29], or considering novel approaches like LV endocardial pacing [10], or multipoint pacing [8] at an early stage if non-responder status if confirmed. Use of auto-optimization algorithms [9], and optimization of medical therapy with novel drugs [11,12] should be pursued in this group of patients to optimize chances of response and survival in this group.…”

Section: Liu Et Al Have Shown That For Same Levels Of Lvef Patientsmentioning

confidence: 99%

Usefulness of a clinical risk score to predict the response to cardiac resynchronization therapy

Providência

Marijon²,

Barra³

et al. 2018

International Journal of Cardiology

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“…Responders, especially superresponders to CRT, are at relatively lower risk of long-term cardiac mortality (3). Whether the primary prevention implantable cardioverter-defibrillator (ICD) improves outcomes over and above CRT is a matter of ongoing debate (4)(5)(6)(7), with the recent CeRtiTuDe cohort study revealing that the majority of the excess mortality among CRT-Pacemaker (CRT-P) subjects at 2-year follow-up is related to an increase in non-SCD (8).…”

Section: Introductionmentioning

confidence: 99%

Very long-term survival and late sudden cardiac death in cardiac resynchronization therapy patients

Barra

Duehmke

Providência

et al. 2019

European Heart Journal

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Aims The very long-term outcome of patients who survive the first few years after receiving cardiac resynchronization therapy (CRT) has not been well described thus far. We aimed to provide long-term outcomes, especially with regard to the occurrence of sudden cardiac death (SCD), in CRT patients without (CRT-P) and with defibrillator (CRT-D). Methods and results A total of 1775 patients, with ischaemic or non-ischaemic dilated cardiomyopathy, who were alive 5 years after CRT implantation, were enrolled in this multicentre European observational cohort study. Overall long-term mortality rates and specific causes of death were assessed, with a focus on late SCD. Over a mean follow-up of 30 months (interquartile range 10–42 months) beyond the first 5 years, we observed 473 deaths. The annual age-standardized mortality rates of CRT-D and CRT-P patients were 40.4 [95% confidence interval (CI) 35.3–45.5] and 97.2 (95% CI 85.5–109.9) per 1000 patient-years, respectively. The adjusted hazard ratio (HR) for all-cause mortality was 0.99 (95% CI 0.79–1.22). Twenty-nine patients in total died of late SCD (14 with CRT-P, 15 with CRT-D), corresponding to 6.1% of all causes of death in both device groups. Specific annual SCD rates were 8.5 and 5.8 per 1000 patient-years in CRT-P and CRT-D patients, respectively, with no significant difference between groups (adjusted HR 1.0, 95% CI 0.45–2.44). Death due to progressive heart failure represented the principal cause of death (42.8% in CRT-P patients and 52.6% among CRT-D recipients), whereas approximately one-third of deaths in both device groups were due to non-cardiovascular death. Conclusion In this first description of very long-term outcomes among CRT recipients, progressive heart failure death still represented the most frequent cause of death in patients surviving the first 5 years after CRT implant. In contrast, SCD represents a very low proportion of late mortality irrespective of the presence of a defibrillator.

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

Abstract: In primary prevention patients with CRT indication, the addition of a defibrillator might convey additional benefit only in well-selected male patients.

Cited by 23 publications

References 28 publications

Cardiac implantable electrical devices in women

Cardiac implantable electrical devices in women

Usefulness of a clinical risk score to predict the response to cardiac resynchronization therapy

Very long-term survival and late sudden cardiac death in cardiac resynchronization therapy patients

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