Neal A Chatterjee1, Rasmus Borgquist2, Yuchiao Chang3, Jennifer Lewey4, Vicki A Jackson5, Jagmeet P Singh1, Joshua P Metlay3, Charlotta Lindvall6. 1. Cardiac Arrhythmia Service and Division of Cardiology, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02114, USA. 2. Department of Cardiology, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden. 3. Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA. 4. Division of Cardiology, Department of Medicine, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA. 5. Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. 6. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston MA 02215, USA.
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, 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. Published on behalf of the European Society of Cardiology. All rights reserved.
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. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Scott D Solomon; Elyse Foster; Mikhail Bourgoun; Amil Shah; Esperanza Viloria; Mary W Brown; W Jackson Hall; Marc A Pfeffer; Arthur J Moss Journal: Circulation Date: 2010-08-23 Impact factor: 29.690
Authors: Sana M Al-Khatib; Anne S Hellkamp; Adrian F Hernandez; Gregg C Fonarow; Kevin L Thomas; Hussein R Al-Khalidi; Paul A Heidenreich; Stephen Hammill; Clyde Yancy; Eric D Peterson Journal: Circulation Date: 2012-01-27 Impact factor: 29.690
Authors: Lars Køber; Jens J Thune; Jens C Nielsen; Jens Haarbo; Lars Videbæk; Eva Korup; Gunnar Jensen; Per Hildebrandt; Flemming H Steffensen; Niels E Bruun; Hans Eiskjær; Axel Brandes; Anna M Thøgersen; Finn Gustafsson; Kenneth Egstrup; Regitze Videbæk; Christian Hassager; Jesper H Svendsen; Dan E Høfsten; Christian Torp-Pedersen; Steen Pehrson Journal: N Engl J Med Date: 2016-08-27 Impact factor: 91.245
Authors: Benjamin A Steinberg; Sana M Al-Khatib; Rex Edwards; JooYoon Han; Gust H Bardy; J Thomas Bigger; Alfred E Buxton; Arthur J Moss; Kerry L Lee; Richard Steinman; Paul Dorian; Alfred Hallstrom; Riccardo Cappato; Alan H Kadish; Peter J Kudenchuk; Daniel B Mark; Lurdes Y T Inoue; Gillian D Sanders Journal: JACC Heart Fail Date: 2014-10-08 Impact factor: 12.035
Authors: Jehu Mathew; Ronit Katz; Martin St John Sutton; Sanjay Dixit; Edward P Gerstenfeld; Stefano Ghio; Michael R Gold; Cecilia Linde; Michael G Shlipak; Rajat Deo Journal: Eur J Heart Fail Date: 2012-09-06 Impact factor: 15.534
Authors: Claire E Raphael; Judith A Finegold; Anthony J Barron; Zachary I Whinnett; Jamil Mayet; Cecilia Linde; John G F Cleland; Wayne C Levy; Darrel P Francis Journal: Eur Heart J Date: 2015-04-23 Impact factor: 29.983
Authors: Elie S Al Kazzi; Brandyn Lau; Tianjing Li; Eric B Schneider; Martin A Makary; Susan Hutfless Journal: PLoS One Date: 2015-11-04 Impact factor: 3.240
Authors: Marat Fudim; Frederik Dalgaard; Sana M Al-Khatib; Daniel J Friedman; Kathryn Lallinger; William T Abraham; John G F Cleland; Anne B Curtis; Michael R Gold; Valentina Kutyifa; Cecilia Linde; Daniel E Schaber; Anthony Tang; Fatima Ali-Ahmed; Sarah A Goldstein; Brystana Kaufman; Robyn Fortman; J Kelly Davis; Lurdes Y T Inoue; Gillian D Sanders Journal: Am Heart J Date: 2020-02-21 Impact factor: 4.749
Authors: Márton Tokodi; Anett Behon; Eperke Dóra Merkel; Attila Kovács; Zoltán Tősér; András Sárkány; Máté Csákvári; Bálint Károly Lakatos; Walter Richard Schwertner; Annamária Kosztin; Béla Merkely Journal: Front Cardiovasc Med Date: 2021-02-25
Authors: Lucy Bolt; Maria M Wertli; Alan G Haynes; Nicolas Rodondi; Arnaud Chiolero; Radoslaw Panczak; Drahomir Aujesky Journal: PLoS One Date: 2022-02-16 Impact factor: 3.240
Authors: Anne G Raafs; Gerard C M Linssen; Jasper J Brugts; Ayten Erol-Yilmaz; Jacobus Plomp; Jeroen P P Smits; Michiel J Nagelsmit; Remko M Oortman; Arno W Hoes; Hans-Peter Brunner-LaRocca Journal: ESC Heart Fail Date: 2020-05-12