Sex‐Specific Differences in Survival and Heart Failure Hospitalization After Cardiac Resynchronization Therapy With or Without Defibrillation
Background Women are underrepresented in cardiac resynchronization therapy (CRT) trials. Some studies suggest that women fare better than men after CRT. We sought to explore clinical outcomes in women and men undergoing CRT‐defibrillation or CRT‐pacing in real‐world clinical practice. Methods and Re...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.013485 |
| _version_ | 1831836272316907520 |
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| author | Francisco Leyva Tian Qiu Abbasin Zegard David McNulty Felicity Evison Daniel Ray Maurizio Gasparini |
| author_facet | Francisco Leyva Tian Qiu Abbasin Zegard David McNulty Felicity Evison Daniel Ray Maurizio Gasparini |
| author_sort | Francisco Leyva |
| collection | DOAJ |
| description | Background Women are underrepresented in cardiac resynchronization therapy (CRT) trials. Some studies suggest that women fare better than men after CRT. We sought to explore clinical outcomes in women and men undergoing CRT‐defibrillation or CRT‐pacing in real‐world clinical practice. Methods and Results A national database (Hospital Episode Statistics for England) was used to quantify clinical outcomes in 43 730 patients (women: 10 890 [24.9%]; men: 32 840 [75.1%]) undergoing CRT over 7.6 years, (median follow‐up 2.2 years, interquartile range, 1–4 years). In analysis of the total population, the primary end point of total mortality (adjusted hazard ratio [aHR], 0.73; 95% CI, 0.69–0.76) and the secondary end point of total mortality or heart failure hospitalization (aHR, 0.79, 95% CI 0.75–0.82) were lower in women, independent of known confounders. Total mortality (aHR, 0.73; 95% CI, 0.70–0.76) and total mortality or heart failure hospitalization (aHR, 0.79; 95% CI, 0.75–0.82) were lower for CRT‐defibrillation than for CRT‐pacing. In analyses of patients with (aHR, 0.89; 95% CI, 0.80–0.98) or without (aHR, 0.70; 95% CI, 0.66–0.73) a myocardial infarction, women had a lower total mortality. In sex‐specific analyses, total mortality was lower after CRT‐defibrillation in women (aHR, 0.83; P=0.013) and men (aHR, 0.69; P<0.001). Conclusions Compared with men, women lived longer and were less likely to be hospitalized for heart failure after CRT. In both sexes, CRT‐defibrillation was superior to CRT‐pacing with respect to survival and heart failure hospitalization. The longest survival after CRT was observed in women without a history of myocardial infarction. |
| first_indexed | 2024-12-23T04:53:31Z |
| format | Article |
| id | doaj.art-04ef17bba7c54f7cbdb31016603a65a9 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-23T04:53:31Z |
| publishDate | 2019-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-04ef17bba7c54f7cbdb31016603a65a92022-12-21T17:59:24ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-11-0182210.1161/JAHA.119.013485Sex‐Specific Differences in Survival and Heart Failure Hospitalization After Cardiac Resynchronization Therapy With or Without DefibrillationFrancisco Leyva0Tian Qiu1Abbasin Zegard2David McNulty3Felicity Evison4Daniel Ray5Maurizio Gasparini6Aston Medical Research Institute Aston Medical School Aston University Birmingham United KingdomQuality and Outcomes Research Unit Queen Elizabeth Hospital Birmingham United KingdomAston Medical Research Institute Aston Medical School Aston University Birmingham United KingdomQuality and Outcomes Research Unit Queen Elizabeth Hospital Birmingham United KingdomQuality and Outcomes Research Unit Queen Elizabeth Hospital Birmingham United KingdomNHS Digital and Farr Institute London United KingdomElectrophysiology and Pacing Unit Humanitas Research Hospital IRCCS Rozzano‐Milano ItalyBackground Women are underrepresented in cardiac resynchronization therapy (CRT) trials. Some studies suggest that women fare better than men after CRT. We sought to explore clinical outcomes in women and men undergoing CRT‐defibrillation or CRT‐pacing in real‐world clinical practice. Methods and Results A national database (Hospital Episode Statistics for England) was used to quantify clinical outcomes in 43 730 patients (women: 10 890 [24.9%]; men: 32 840 [75.1%]) undergoing CRT over 7.6 years, (median follow‐up 2.2 years, interquartile range, 1–4 years). In analysis of the total population, the primary end point of total mortality (adjusted hazard ratio [aHR], 0.73; 95% CI, 0.69–0.76) and the secondary end point of total mortality or heart failure hospitalization (aHR, 0.79, 95% CI 0.75–0.82) were lower in women, independent of known confounders. Total mortality (aHR, 0.73; 95% CI, 0.70–0.76) and total mortality or heart failure hospitalization (aHR, 0.79; 95% CI, 0.75–0.82) were lower for CRT‐defibrillation than for CRT‐pacing. In analyses of patients with (aHR, 0.89; 95% CI, 0.80–0.98) or without (aHR, 0.70; 95% CI, 0.66–0.73) a myocardial infarction, women had a lower total mortality. In sex‐specific analyses, total mortality was lower after CRT‐defibrillation in women (aHR, 0.83; P=0.013) and men (aHR, 0.69; P<0.001). Conclusions Compared with men, women lived longer and were less likely to be hospitalized for heart failure after CRT. In both sexes, CRT‐defibrillation was superior to CRT‐pacing with respect to survival and heart failure hospitalization. The longest survival after CRT was observed in women without a history of myocardial infarction.https://www.ahajournals.org/doi/10.1161/JAHA.119.013485cardiac resynchronization therapyfemale seximplantable cardioverter defibrillator |
| spellingShingle | Francisco Leyva Tian Qiu Abbasin Zegard David McNulty Felicity Evison Daniel Ray Maurizio Gasparini Sex‐Specific Differences in Survival and Heart Failure Hospitalization After Cardiac Resynchronization Therapy With or Without Defibrillation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac resynchronization therapy female sex implantable cardioverter defibrillator |
| title | Sex‐Specific Differences in Survival and Heart Failure Hospitalization After Cardiac Resynchronization Therapy With or Without Defibrillation |
| title_full | Sex‐Specific Differences in Survival and Heart Failure Hospitalization After Cardiac Resynchronization Therapy With or Without Defibrillation |
| title_fullStr | Sex‐Specific Differences in Survival and Heart Failure Hospitalization After Cardiac Resynchronization Therapy With or Without Defibrillation |
| title_full_unstemmed | Sex‐Specific Differences in Survival and Heart Failure Hospitalization After Cardiac Resynchronization Therapy With or Without Defibrillation |
| title_short | Sex‐Specific Differences in Survival and Heart Failure Hospitalization After Cardiac Resynchronization Therapy With or Without Defibrillation |
| title_sort | sex specific differences in survival and heart failure hospitalization after cardiac resynchronization therapy with or without defibrillation |
| topic | cardiac resynchronization therapy female sex implantable cardioverter defibrillator |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.013485 |
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