Gender-specific differences in clinical outcome of primary prevention implantable cardioverter defibrillator recipients

• Published in: Heart (British Cardiac Society) Vol. 99; no. 17; pp. 1244 - 1249
• Main Authors: van der Heijden, Aafke C, Thijssen, Joep, Borleffs, C Jan Willem, van Rees, Johannes B, Höke, Ulas, van der Velde, Enno T, van Erven, Lieselot, Schalij, Martin J
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Cardiovascular Society 01.09.2013; BMJ Publishing Group LTD
• Subjects: Aged; Arrhythmias; Arrhythmias, Cardiac - therapy; Cardiac arrhythmia; Cardiovascular disease; Clinical outcomes; Cohort Studies; Coronary Artery Disease - therapy; Death, Sudden, Cardiac - prevention & control; Defibrillators; Defibrillators, Implantable - statistics & numerical data; Female; Gender differences; Heart attacks; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Mortality; Proportional Hazards Models; Prospective Studies; Sex Factors; Treatment Outcome; United States > US; Minnesota; Arrhythmias
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2013-304013

Objective To assess differences in clinical outcome of implantable cardioverter-defibrillator (ICD) treatment in men and women. Design Prospective cohort study. Setting University Medical Center. Patients 1946 primary prevention ICD recipients (1528 (79%) men and 418 (21%) women). Patients with congenital heart disease were excluded for this analysis. Main outcome measures All-cause mortality, ICD therapy (antitachycardia pacing and shock) and ICD shock. Results During a median follow-up of 3.3 years (25th–75th percentile 1.4–5.4), 387 (25%) men and 76 (18%) women died. The estimated 5-year cumulative incidence for all-cause mortality was 20% (95% CI 18% to 23%) for men and 14% (95% CI 9% to 19%) for women (log rank p<0.01). After adjustment for potential confounding covariates all-cause mortality was lower in women (HR 0.65; 95% CI 0.49 to 0.84; p<0.01). The 5-year cumulative incidence for appropriate therapy in men was 24% (95% CI 21% to 28%) as compared with 20% (95% CI 14% to 26%) in women (log rank p=0.07). After adjustment, a non-significant trend remained (HR 0.82; 95% CI 0.64 to 1.06; p=0.13). Conclusions In clinical practice, 21% of primary prevention ICD recipients are women. Women have lower mortality and tend to experience less appropriate ICD therapy as compared with their male peers.