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The Gender‐Paradox among Patients with Implantable Cardioverter‐Defibrillators: A Propensity‐Matched Study
Author(s) -
BHAVNANI SANJEEV P.,
PAVULURI VAMSIMOHAN,
COLEMAN CRAIG I.,
GUERTIN DANETTE,
YARLAGADDA RAVI K.,
CLYNE CHRISTOPHER A.,
KLUGER JEFFERY
Publication year - 2013
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12141
Subject(s) - medicine , implantable cardioverter defibrillator , propensity score matching , medline , cardiology , medical emergency , political science , law
Background Several meta‐analyses of the implantable cardioverter‐defibrillator (ICD) clinical trials have demonstrated that while men derived a mortality reduction with prophylactic ICD implantation, women did not. These trials also observed that women receive less appropriate ICD shock therapy compared to men. We aimed to investigate this “gender‐paradox” among a heterogeneous community cohort of patients receiving ICDs. Methods We identified 1,445 consecutive patients undergoing ICD implantation from 1997 to 2007. The study population consisted of 582 patients, of whom 291 were women who could be propensity matched to 291 men, based on age, ejection fraction, implantation indication (primary or secondary), etiology of cardiomyopathy (ischemic or nonischemic), and the presence of a cardiac resynchronization therapy‐defibrillator (CRT‐D) device. The impact of gender difference on the probability of death and appropriate ICD shocks for ventricular arrhythmias was calculated using multivariable Cox proportional hazards analyses. Results During a mean follow‐up of 909 ± 901 days, compared to men, women demonstrated a similar risk of death (25% vs 25%, adjusted hazard ratio [AHR] 1.05 [95% confidence interval (CI) 0.81–1.35], P = 0.74). In contrast, women demonstrated a decreased probability of appropriate ICD‐shock therapy (14% vs 19%, AHR 0.80 [95% CI 0.59–0.88], P = 0.03) compared to men, and among cohorts with a nonischemic cardiomyopathy (10% vs 20%, P < 0.001) and CRT‐D devices (7% vs 19%, P = 0.01). Conclusion Among a community cohort with ICDs, women have a similar mortality compared to men while experiencing less appropriate ICD therapy. These results support the findings of a lower arrhythmic mortality among women.