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ICDs for women with HF yielded no additional benefit for prevention of mortality
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Women with HF derived no additional survival benefit from implantable cardioverter defibrillators compared with women who did not receive them.
Researchers conducted a meta-analysis that included data from five randomized clinical trials of ICD implantation vs. medical therapy for the primary prevention of sudden cardiac death in patients with HF. Included were 3,810 men and 934 women pooled from the MADIT II, MUSTT, DINAMIT, DEFINITE and SCD-HeFT trials. Four additional trials were excluded from the analysis because their results did not report the outcome of interest for women.
The researchers reported a decrease in mortality rates in men with HF and reduced left ventricular ejection fraction who received ICDs for the primary prevention of sudden cardiac death vs. those receiving medical therapy (HR=0.78; 95% CI, 0.70-0.87). No significant survival benefit from ICD implantation vs. medical therapy was reported for women, however (HR=1.01; 95% CI, 0.76-1.33). The researchers reported that none of the results from the individual trials suggested a significant interaction between sex and ICD therapy on overall mortality. Minimal trial heterogeneity of the results was reported for both the male (P=.083) and female (P=.24) populations.
“Our analysis demonstrated that ICD therapy for the primary prevention of sudden cardiac death in women does not affect all-cause mortality rates,” the researchers concluded. “There may be several explanations for this important and surprising finding. Further studies are warranted to investigate the reasons for this observation and to elucidate the female population who may benefit most from ICD therapy.”
Ghanbari H. Arch Intern Med. 2009;169:1500-1506.