Sex‐specific differences in outcome and risk stratification of ventricular arrhythmias in implantable cardioverter defibrillator patients
Abstract Aims Risk stratification models of sudden cardiac death (SCD) are based on the assumption that risk factors of SCD affect risk to a similar extent in both sexes. The aim of the study is to evaluate differences in clinical outcomes between sexes and evaluate whether risk factors associated w...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-10-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.13444 |
| _version_ | 1818738119311097856 |
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| author | Anne‐Lotte C.J. van derLingen Dominic A.M.J. Theuns Mischa T. Rijnierse Marthe A.J. Becker Peter M. van deVen Albert C. vanRossum Vokko P. vanHalm Michiel J.B. Kemme Sing C. Yap Cornelis P. Allaart |
| author_facet | Anne‐Lotte C.J. van derLingen Dominic A.M.J. Theuns Mischa T. Rijnierse Marthe A.J. Becker Peter M. van deVen Albert C. vanRossum Vokko P. vanHalm Michiel J.B. Kemme Sing C. Yap Cornelis P. Allaart |
| author_sort | Anne‐Lotte C.J. van derLingen |
| collection | DOAJ |
| description | Abstract Aims Risk stratification models of sudden cardiac death (SCD) are based on the assumption that risk factors of SCD affect risk to a similar extent in both sexes. The aim of the study is to evaluate differences in clinical outcomes between sexes and evaluate whether risk factors associated with appropriate device therapy (ADT) differ between men and women. Methods and results We performed a cohort study of implantable cardioverter defibrillator (ICD) patients referred for primary or secondary prevention of SCD between 2009 and 2018. Multivariable Cox regression models for prediction of ADT were constructed for men and women separately. Of 2300 included patients, 571 (25%) were women. Median follow‐up was 4.6 (inter‐quartile range: 4.4–4.9) years. Time to ADT was shorter for men compared with women [hazard ratio (HR) 1.71, P < 0.001], as was time to mortality (HR 1.37, P = 0.003). In women, only secondary prevention ICD therapy (HR 1.82, P < 0.01) was associated with ADT, whereas higher age (HR 1.20, P < 0.001), absence of left bundle branch block (HR 0.72, P = 0.01), and secondary prevention therapy (HR 1.80, P < 0.001) were independently associated with ADT in men. None of the observed parameters showed a distinctive sex‐specific pattern in ADT. Conclusions Male ICD patients were at higher risk of ADT and death compared with female ICD patients, irrespective of an ischaemic or non‐ischaemic underlying cardiomyopathy. Our study highlights the importance to stratify outcomes of ICD trials by sex, as study results differ between men and women. However, none of the available clinical parameters showed a clear sex‐specific relation to ventricular arrhythmias. As a consequence, sex‐specific risk stratification models of SCD using commonly available clinical parameters could not be derived. |
| first_indexed | 2024-12-18T01:03:52Z |
| format | Article |
| id | doaj.art-46bdb72b19104aa382ec0786781db1fc |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-18T01:03:52Z |
| publishDate | 2021-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-46bdb72b19104aa382ec0786781db1fc2022-12-21T21:26:18ZengWileyESC Heart Failure2055-58222021-10-01853726373610.1002/ehf2.13444Sex‐specific differences in outcome and risk stratification of ventricular arrhythmias in implantable cardioverter defibrillator patientsAnne‐Lotte C.J. van derLingen0Dominic A.M.J. Theuns1Mischa T. Rijnierse2Marthe A.J. Becker3Peter M. van deVen4Albert C. vanRossum5Vokko P. vanHalm6Michiel J.B. Kemme7Sing C. Yap8Cornelis P. Allaart9Department of Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, Vrije Universiteit Amsterdam De Boelelaan 1117 Amsterdam 1081 HV The NetherlandsDepartment of Cardiology Erasmus University Medical Center Rotterdam The NetherlandsDepartment of Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, Vrije Universiteit Amsterdam De Boelelaan 1117 Amsterdam 1081 HV The NetherlandsDepartment of Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, Vrije Universiteit Amsterdam De Boelelaan 1117 Amsterdam 1081 HV The NetherlandsDepartment of Epidemiology and Data Science Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The NetherlandsDepartment of Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, Vrije Universiteit Amsterdam De Boelelaan 1117 Amsterdam 1081 HV The NetherlandsDepartment of Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, Vrije Universiteit Amsterdam De Boelelaan 1117 Amsterdam 1081 HV The NetherlandsDepartment of Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, Vrije Universiteit Amsterdam De Boelelaan 1117 Amsterdam 1081 HV The NetherlandsDepartment of Cardiology Erasmus University Medical Center Rotterdam The NetherlandsDepartment of Cardiology, Amsterdam Cardiovascular Sciences Amsterdam UMC, Vrije Universiteit Amsterdam De Boelelaan 1117 Amsterdam 1081 HV The NetherlandsAbstract Aims Risk stratification models of sudden cardiac death (SCD) are based on the assumption that risk factors of SCD affect risk to a similar extent in both sexes. The aim of the study is to evaluate differences in clinical outcomes between sexes and evaluate whether risk factors associated with appropriate device therapy (ADT) differ between men and women. Methods and results We performed a cohort study of implantable cardioverter defibrillator (ICD) patients referred for primary or secondary prevention of SCD between 2009 and 2018. Multivariable Cox regression models for prediction of ADT were constructed for men and women separately. Of 2300 included patients, 571 (25%) were women. Median follow‐up was 4.6 (inter‐quartile range: 4.4–4.9) years. Time to ADT was shorter for men compared with women [hazard ratio (HR) 1.71, P < 0.001], as was time to mortality (HR 1.37, P = 0.003). In women, only secondary prevention ICD therapy (HR 1.82, P < 0.01) was associated with ADT, whereas higher age (HR 1.20, P < 0.001), absence of left bundle branch block (HR 0.72, P = 0.01), and secondary prevention therapy (HR 1.80, P < 0.001) were independently associated with ADT in men. None of the observed parameters showed a distinctive sex‐specific pattern in ADT. Conclusions Male ICD patients were at higher risk of ADT and death compared with female ICD patients, irrespective of an ischaemic or non‐ischaemic underlying cardiomyopathy. Our study highlights the importance to stratify outcomes of ICD trials by sex, as study results differ between men and women. However, none of the available clinical parameters showed a clear sex‐specific relation to ventricular arrhythmias. As a consequence, sex‐specific risk stratification models of SCD using commonly available clinical parameters could not be derived.https://doi.org/10.1002/ehf2.13444Implantable cardioverter defibrillatorSex differencesSudden cardiac deathRisk stratification |
| spellingShingle | Anne‐Lotte C.J. van derLingen Dominic A.M.J. Theuns Mischa T. Rijnierse Marthe A.J. Becker Peter M. van deVen Albert C. vanRossum Vokko P. vanHalm Michiel J.B. Kemme Sing C. Yap Cornelis P. Allaart Sex‐specific differences in outcome and risk stratification of ventricular arrhythmias in implantable cardioverter defibrillator patients ESC Heart Failure Implantable cardioverter defibrillator Sex differences Sudden cardiac death Risk stratification |
| title | Sex‐specific differences in outcome and risk stratification of ventricular arrhythmias in implantable cardioverter defibrillator patients |
| title_full | Sex‐specific differences in outcome and risk stratification of ventricular arrhythmias in implantable cardioverter defibrillator patients |
| title_fullStr | Sex‐specific differences in outcome and risk stratification of ventricular arrhythmias in implantable cardioverter defibrillator patients |
| title_full_unstemmed | Sex‐specific differences in outcome and risk stratification of ventricular arrhythmias in implantable cardioverter defibrillator patients |
| title_short | Sex‐specific differences in outcome and risk stratification of ventricular arrhythmias in implantable cardioverter defibrillator patients |
| title_sort | sex specific differences in outcome and risk stratification of ventricular arrhythmias in implantable cardioverter defibrillator patients |
| topic | Implantable cardioverter defibrillator Sex differences Sudden cardiac death Risk stratification |
| url | https://doi.org/10.1002/ehf2.13444 |
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