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

Barra, Sérgio; Providência, Rui; Duehmke, Rudolf; Boveda, Serge; Marijon, Eloi; Reitan, Christian LU ; Borgquist, Rasmus LU ; Klug, Didier; Defaye, Pascal and Sadoul, Nicolas, et al. (2017) In Heart 103(10). p.753-760
Abstract

Objective Among primary prevention patients with heart failure receiving cardiac resynchronisation therapy (CRT), the impact of additional implantable cardioverter defibrillator (ICD) treatment on outcomes and its interaction with sex remains uncertain. We aim to assess whether the addition of the ICD functionality to CRT devices offers a more pronounced survival benefit in men compared with women, as previous research has suggested. Methods Observational multicentre cohort study of 5307 consecutive patients with ischaemic or nonischaemic dilated cardiomyopathy and no history of sustained ventricular arrhythmias having CRT implantation with (cardiac resynchronisation therapy defibrillator (CRT-D), n=4037) or without (cardiac... (More)

Objective Among primary prevention patients with heart failure receiving cardiac resynchronisation therapy (CRT), the impact of additional implantable cardioverter defibrillator (ICD) treatment on outcomes and its interaction with sex remains uncertain. We aim to assess whether the addition of the ICD functionality to CRT devices offers a more pronounced survival benefit in men compared with women, as previous research has suggested. Methods Observational multicentre cohort study of 5307 consecutive patients with ischaemic or nonischaemic dilated cardiomyopathy and no history of sustained ventricular arrhythmias having CRT implantation with (cardiac resynchronisation therapy defibrillator (CRT-D), n=4037) or without (cardiac resynchronisation therapy pacemaker (CRT-P), n=1270) defibrillator functionality. Using propensity score (PS) matching and weighting and cause-of-death data, we assessed and compared the outcome of patients with CRT-D versus CRT-P. This analysis was stratified according to sex. Results After a median follow-up of 34 months (interquartile range 22-60 months) no survival advantage, of CRT-D versus CRT-P was observed in both men and women after PS matching (HR=0.95, 95% CI 0.77 to 1.16, p=0.61, and HR=1.30, 95% CI 0.83 to 2.04, p=0.25, respectively). With inverse-probability weighting, a benefit of CRT-D was seen in male patients (HR 0.78, 95% CI 0.65 to 0.94, p=0.012) but not in women (HR 0.87, 95% CI 0.63 to 1.19, p=0.43). The excess unadjusted mortality of patients with CRT-P compared with CRT-D was related to sudden cardiac death in 7.4% of cases in men but only 2.2% in women. Conclusions In primary prevention patients with CRT indication, the addition of a defibrillator might convey additional benefit only in well-selected male patients.

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published
subject
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Heart
volume
103
issue
10
pages
753 - 760
publisher
BMJ Publishing Group
external identifiers
  • scopus:85011112367
  • wos:000401023900008
ISSN
1355-6037
DOI
10.1136/heartjnl-2016-310677
language
English
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yes
id
f5b138ec-2ceb-4488-8aec-aea8c99438ff
date added to LUP
2017-02-15 09:23:58
date last changed
2018-01-07 11:49:58
@article{f5b138ec-2ceb-4488-8aec-aea8c99438ff,
  abstract     = {<p>Objective Among primary prevention patients with heart failure receiving cardiac resynchronisation therapy (CRT), the impact of additional implantable cardioverter defibrillator (ICD) treatment on outcomes and its interaction with sex remains uncertain. We aim to assess whether the addition of the ICD functionality to CRT devices offers a more pronounced survival benefit in men compared with women, as previous research has suggested. Methods Observational multicentre cohort study of 5307 consecutive patients with ischaemic or nonischaemic dilated cardiomyopathy and no history of sustained ventricular arrhythmias having CRT implantation with (cardiac resynchronisation therapy defibrillator (CRT-D), n=4037) or without (cardiac resynchronisation therapy pacemaker (CRT-P), n=1270) defibrillator functionality. Using propensity score (PS) matching and weighting and cause-of-death data, we assessed and compared the outcome of patients with CRT-D versus CRT-P. This analysis was stratified according to sex. Results After a median follow-up of 34 months (interquartile range 22-60 months) no survival advantage, of CRT-D versus CRT-P was observed in both men and women after PS matching (HR=0.95, 95% CI 0.77 to 1.16, p=0.61, and HR=1.30, 95% CI 0.83 to 2.04, p=0.25, respectively). With inverse-probability weighting, a benefit of CRT-D was seen in male patients (HR 0.78, 95% CI 0.65 to 0.94, p=0.012) but not in women (HR 0.87, 95% CI 0.63 to 1.19, p=0.43). The excess unadjusted mortality of patients with CRT-P compared with CRT-D was related to sudden cardiac death in 7.4% of cases in men but only 2.2% in women. Conclusions In primary prevention patients with CRT indication, the addition of a defibrillator might convey additional benefit only in well-selected male patients.</p>},
  author       = {Barra, Sérgio and Providência, Rui and Duehmke, Rudolf and Boveda, Serge and Marijon, Eloi and Reitan, Christian and Borgquist, Rasmus and Klug, Didier and Defaye, Pascal and Sadoul, Nicolas and Deharo, Jean Claude and Sadien, Iannish and Patel, Kiran and Looi, Khang Li and Begley, David and Chow, Anthony W. and Heuzey, Jean Yves Le and Agarwal, Sharad},
  issn         = {1355-6037},
  language     = {eng},
  month        = {01},
  number       = {10},
  pages        = {753--760},
  publisher    = {BMJ Publishing Group},
  series       = {Heart},
  title        = {Sex-specific outcomes with addition of defibrillation to resynchronisation therapy in patients with heart failure},
  url          = {http://dx.doi.org/10.1136/heartjnl-2016-310677},
  volume       = {103},
  year         = {2017},
}