Dominique de Waard1, Jaimie Manlucu2, Anne M Gillis3, John Sapp4, Jordan Bernick5, Steve Doucette6, Anthony Tang2, George Wells5, Ratika Parkash7. 1. Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. 2. London Health Sciences Center, University of Western Ontario, London, Ontario, Canada. 3. Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada. 4. Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada. 5. Ottawa Cardiovascular Research Methods Center, Ottawa, Ontario, Canada. 6. Research Methods Unit, Halifax, Nova Scotia, Canada. 7. Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada. Electronic address: ratika.parkash@nshealth.ca.
Abstract
OBJECTIVES: This study sought to evaluate the effect of cardiac resynchronization therapy with defibrillator (CRT-D) as compared with implantable cardioverter-defibrillator (ICD) on mortality, heart failure (HF) hospitalization, and ventricular arrhythmia in women versus men. BACKGROUND:CRT-D has demonstrated reduced mortality and HF hospitalizations with greater benefit observed in women compared with men. However, whether CRT-D prevented ventricular arrhythmias in women compared with men was unclear. METHODS: The RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure Trial) study randomized 1,798 patients to an ICD or CRT-D. In this post hoc analysis, women and men were compared by randomized group. By using a multivariable model, the outcomes of death and HF hospitalization and incidence of ventricular arrhythmia were compared between men and women. RESULTS: There were 1,490 (83%) men (732, ICD; 758, CRT-D) and 308 (17%) women (172, ICD; 136, CRT-D) included in the analysis. Women with CRT-D had a significantly reduced incidence of death and HF hospitalization compared with men with CRT-D (hazard ratio: 0.52; 95% confidence interval: 0.33 to 0.81; p < 0.001) on multivariable analysis. Women with a primary prevention indication and CRT-D had the lowest rate of ventricular arrhythmia compared with men (hazard ratio: 0.59; 95% confidence interval: 0.39 to 0.91; p = 0.016). CONCLUSIONS:Women have improved rates of death and HF hospitalization with CRT-D and were less likely to experience ventricular arrhythmia when compared with men, after adjusting for differences in baseline characteristics over a prolonged follow-up. Whether these improved outcomes reflect inherent sex differences in the underlying myocardial substrate resulting in an enhanced response to CRT-D requires further research.
RCT Entities:
OBJECTIVES: This study sought to evaluate the effect of cardiac resynchronization therapy with defibrillator (CRT-D) as compared with implantable cardioverter-defibrillator (ICD) on mortality, heart failure (HF) hospitalization, and ventricular arrhythmia in women versus men. BACKGROUND: CRT-D has demonstrated reduced mortality and HF hospitalizations with greater benefit observed in women compared with men. However, whether CRT-D prevented ventricular arrhythmias in women compared with men was unclear. METHODS: The RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure Trial) study randomized 1,798 patients to an ICD or CRT-D. In this post hoc analysis, women and men were compared by randomized group. By using a multivariable model, the outcomes of death and HF hospitalization and incidence of ventricular arrhythmia were compared between men and women. RESULTS: There were 1,490 (83%) men (732, ICD; 758, CRT-D) and 308 (17%) women (172, ICD; 136, CRT-D) included in the analysis. Women with CRT-D had a significantly reduced incidence of death and HF hospitalization compared with men with CRT-D (hazard ratio: 0.52; 95% confidence interval: 0.33 to 0.81; p < 0.001) on multivariable analysis. Women with a primary prevention indication and CRT-D had the lowest rate of ventricular arrhythmia compared with men (hazard ratio: 0.59; 95% confidence interval: 0.39 to 0.91; p = 0.016). CONCLUSIONS:Women have improved rates of death and HF hospitalization with CRT-D and were less likely to experience ventricular arrhythmia when compared with men, after adjusting for differences in baseline characteristics over a prolonged follow-up. Whether these improved outcomes reflect inherent sex differences in the underlying myocardial substrate resulting in an enhanced response to CRT-D requires further research.
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: Mohammad K Syed; Hassan I Sheikh; Bradley McKay; Nicholas Tseng; Maureen Pakosh; Jessica E Caterini; Abhinav Sharma; Tracey J F Colella; Kaja M Konieczny; Kim A Connelly; Michelle M Graham; Michael McDonald; Laura Banks; Varinder Kaur Randhawa Journal: CJC Open Date: 2021-09-24
Authors: Bradley McKay; Nicholas W H Tseng; Hassan I Sheikh; Mohammad K Syed; Maureen Pakosh; Jessica E Caterini; Abhinav Sharma; Tracey J F Colella; Kaja M Konieczny; Kim A Connelly; Michelle M Graham; Michael McDonald; Laura Banks; Varinder Kaur Randhawa Journal: CJC Open Date: 2021-09-15
Authors: Valentina Kutyifa; Mary W Brown; Christopher A Beck; Scott McNitt; Crystal Miller; Karlene Cox; Wojciech Zareba; Spencer Z Rosero; Marye J Gleva; Jeanne E Poole Journal: Heart Rhythm O2 Date: 2020-11-10