Appropriate ICD interventions found lacking in women

Women had less appropriate implantable cardioverter defibrillator interventions compared with men, although there was no apparent difference with mortality, data from a study appearing in Heart Rhythm suggested.

The Texas- and Italy-based researchers utilized PubMed, Central and other databases to find studies that examined gender differences in the specified endpoints, provided the HR obtained in multiple Cox regression analyses and adjusted for all confounding variables.

They found five studies that enrolled patients (n=7,229, 22% women) with dilated cardiomyopathy. Women had no significant difference in overall mortality (HR=0.96; 95% CI, 0.67–1.39) vs. men, but had less appropriate ICD interventions (HR=0.63; 95% CI, 0.49–0.82). The ICD benefit on mortality was greater in men (HR=0.67; 95% CI, 0.58–0.78), whereas it did not attain statistical significance in women (HR=0.78; 95% CI, 0.57–1.05). Women tended to have more advanced disease than men, including a higher percentage of NYHA functional class >II (mean difference, 6.3%) and left bundle-branch block (mean difference, 7%), and more use of diuretics (mean difference, 8.7%).

This study’s findings, the researchers wrote, challenge current left ventricular ejection fraction-based prophylactic ICD recommendations and raise concerns about generalizing such recommendations to underrepresented patients in primary prevention ICD trials. These findings, they added, “call for further research with appropriate economic and social analyses to determine the cost-effectiveness of this therapy in women.”

To read the free full text of this study, visit here.

Santangeli P. Heart Rhythm. 2010;7:876–882.

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