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Increasing sex differences in the use of cardiac resynchronization therapy with or without implantable cardioverter-defibrillator

Chatterjee, Neal A; Borgquist, Rasmus LU ; Chang, Yuchiao; Lewey, Jennifer; Jackson, Vicki A; Singh, Jagmeet P; Metlay, Joshua P and Lindvall, Charlotta (2017) In European Heart Journal 38(19). p.1485-1494
Abstract

AIMS: Previous studies have identified sex disparities in the use of cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD), although the basis of underutilization in women remains poorly understood. The aim of this study was to assess sex differences in patterns of CRT use with our without ICD.

METHODS AND RESULTS: In this cross-sectional study using the National Inpatient Sample database we identified 311 009 patients undergoing CRT implantation in the United States between 2006 and 2012. Demographic and clinical characteristics were compared between men and women undergoing CRT implantation, with special attention to clinical predictors of left ventricular reverse remodelling (CRT response,... (More)

AIMS: Previous studies have identified sex disparities in the use of cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD), although the basis of underutilization in women remains poorly understood. The aim of this study was to assess sex differences in patterns of CRT use with our without ICD.

METHODS AND RESULTS: In this cross-sectional study using the National Inpatient Sample database we identified 311 009 patients undergoing CRT implantation in the United States between 2006 and 2012. Demographic and clinical characteristics were compared between men and women undergoing CRT implantation, with special attention to clinical predictors of left ventricular reverse remodelling (CRT response, score range: 0-4) and reduced ICD efficacy (score range: 0-7). When compared to men, women undergoing CRT implantation were significantly more likely to have ≥ 3 predictors of CRT response (47.3 vs. 33.2%, P < 0.001) and less likely to have ≥3 predictors of reduced ICD efficacy (27.0 vs. 37.3%, P < 0.001). Despite this, men were significantly more likely to undergo CRT with ICD (CRT-D) as the type of CRT (88.6 vs. 80.1% of all CRT implants). Compared to those with the greatest likelihood of CRT response (score ≥ 3), those with the least likelihood of CRT response had a significant decreased odds of CRT-D implant (adj odds ratio 0.27 [0.24-0.31], P < 0.001), with a greater decreased odds in women compared to men (P, for sex interaction <0.001). The difference in the % of CRT-D implant in men vs. women increased over the study period (P, sex Δ time trend = 0.012).

CONCLUSION: In this large, contemporary cohort, sex differences in CRT-D implantation were inversely related to predicted CRT efficacy and have increased over time. Future efforts to narrow the gap in CRT-D implantation in men and women may help better align device selection with those most likely to benefit.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Journal Article
in
European Heart Journal
volume
38
issue
19
pages
1485 - 1494
publisher
Oxford University Press
external identifiers
  • wos:000401133200012
  • scopus:85039066777
ISSN
1522-9645
DOI
10.1093/eurheartj/ehw598
language
English
LU publication?
yes
id
7e1daf56-10e1-480d-a3f6-a95c8b3f9d66
date added to LUP
2017-04-07 15:12:35
date last changed
2018-01-07 11:58:25
@article{7e1daf56-10e1-480d-a3f6-a95c8b3f9d66,
  abstract     = {<p>AIMS: Previous studies have identified sex disparities in the use of cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD), although the basis of underutilization in women remains poorly understood. The aim of this study was to assess sex differences in patterns of CRT use with our without ICD.</p><p>METHODS AND RESULTS: In this cross-sectional study using the National Inpatient Sample database we identified 311 009 patients undergoing CRT implantation in the United States between 2006 and 2012. Demographic and clinical characteristics were compared between men and women undergoing CRT implantation, with special attention to clinical predictors of left ventricular reverse remodelling (CRT response, score range: 0-4) and reduced ICD efficacy (score range: 0-7). When compared to men, women undergoing CRT implantation were significantly more likely to have ≥ 3 predictors of CRT response (47.3 vs. 33.2%, P &lt; 0.001) and less likely to have ≥3 predictors of reduced ICD efficacy (27.0 vs. 37.3%, P &lt; 0.001). Despite this, men were significantly more likely to undergo CRT with ICD (CRT-D) as the type of CRT (88.6 vs. 80.1% of all CRT implants). Compared to those with the greatest likelihood of CRT response (score ≥ 3), those with the least likelihood of CRT response had a significant decreased odds of CRT-D implant (adj odds ratio 0.27 [0.24-0.31], P &lt; 0.001), with a greater decreased odds in women compared to men (P, for sex interaction &lt;0.001). The difference in the % of CRT-D implant in men vs. women increased over the study period (P, sex Δ time trend = 0.012).</p><p>CONCLUSION: In this large, contemporary cohort, sex differences in CRT-D implantation were inversely related to predicted CRT efficacy and have increased over time. Future efforts to narrow the gap in CRT-D implantation in men and women may help better align device selection with those most likely to benefit.</p>},
  author       = {Chatterjee, Neal A and Borgquist, Rasmus and Chang, Yuchiao and Lewey, Jennifer and Jackson, Vicki A and Singh, Jagmeet P and Metlay, Joshua P and Lindvall, Charlotta},
  issn         = {1522-9645},
  keyword      = {Journal Article},
  language     = {eng},
  month        = {01},
  number       = {19},
  pages        = {1485--1494},
  publisher    = {Oxford University Press},
  series       = {European Heart Journal},
  title        = {Increasing sex differences in the use of cardiac resynchronization therapy with or without implantable cardioverter-defibrillator},
  url          = {http://dx.doi.org/10.1093/eurheartj/ehw598},
  volume       = {38},
  year         = {2017},
}