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ICDs for primary prevention reduce risk for death in women, men with HF
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An implantable cardioverter defibrillator may lower the risk for death by more than 20% in both women and men with HF and reduced left ventricular ejection fraction, according to new data published in Circulation: Heart Failure.
Results of previous randomized clinical trials have suggested that patients with HF live longer when they have an ICD for primary prevention, but these trials included mostly men and little data are available on the benefits of ICDs specifically for women.
“Despite current guidelines recommending that health practitioners consider adding these devices to standard [HF] treatments in both women and men, women with [HF] have been less likely to receive defibrillators,” Emily Zeitler, MD, cardiology and research fellow at Duke Clinical Research Institute, said in a press release. “These new data reinforce the existing gender-neutral guidelines.”
Zeitler and colleagues analyzed Medicare data from 264 hospitals included in the Get With the Guidelines-HF registry to compare survival rates with a preventive or prescribed ICD or without an ICD in both men and women with HF.
Zeitler and colleagues propensity-matched 430 women with HF who received a primary prevention ICD or who were prescribed one during hospitalization vs. 430 women who did not receive an ICD. For comparison, the researchers matched 859 men who received an ICD or were prescribed one during hospitalization vs. 859 who did not receive an ICD.
All-cause mortality was the primary outcome.
At 3-year follow-up, 40.2% of the women with ICDs had died compared with 48.7% of women without ICDs. As a result, the overall risk for mortality was lower in women with an ICD vs. those without an ICD (HR = 0.78; 95% CI, 0.66-0.92). The researchers observed similar results among men, with an HR for mortality of 0.76 (95% CI, 0.067-0.087). Nearly 43% of men with ICDs died during follow-up compared with 52.9% of men without ICDs.
When adjusted for covariates such as diabetes and hypertension, the risk for mortality in both men (P < .001) and women (P = .002) remained the same.
“Although this analysis and others demonstrate a mortality benefit for women from a primary prevention ICD, this benefit must be weighed against potential risks. This is particularly important for women because complication rates associated with primary prevention ICD implantation tend to be higher than men,” Zeitler and colleagues wrote. “Future research is needed to identify ways to reduce complication rates to maximize the net benefit from primary prevention ICDs in women.” – by Tracey Romero
Disclosure: One researcher reports consulting for Medtronic. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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