Sex differences in outcomes of primary prevention implantable cardioverter-defibrillator therapy: combined registry data from eleven European countries
Christian Sticherling,Barbora Arendacká,Jesper Hastrup Svendsen,Sofieke C. Wijers,Tim Friede,Jochem Stockinger,Michael Dommasch,Béla Merkely,Rik Willems,Andrzej Lubiński,Michael Scharfe,Frieder Braunschweig,Martin Svetlosak,Christine S. Zürn,Heikki V. Huikuri,Panagiota Flevari,Caspar Lund-Andersen,Beat Schaer,Anton E. Tuinenburg,Leonard Bergau,Georg Schmidt,Gábor Széplaki,Bert Vandenberk,Emilia Kowalczyk,Christian Eick,Juhani Juntilla,David Conen,Markus Zabel,Eu-Cert-Icd Investigators +28 more
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TLDR
It is demonstrated that fewer women than men undergo ICD implantation for primary prevention after multivariate adjustment, women have a significantly lower mortality and receive fewer appropriate ICD shocks.Abstract:
Aims Therapy with an implantable cardioverter defibrillator (ICD) is established for the prevention of sudden cardiac death (SCD) in high risk patients. We aimed to determine the effectiveness of primary prevention ICD therapy by analysing registry data from 14 centres in 11 European countries compiled between 2002 and 2014, with emphasis on outcomes in women who have been underrepresented in all trials. Methods and results Retrospective data of 14 local registries of primary prevention ICD implantations between 2002 and 2014 were compiled in a central database. Predefined primary outcome measures were overall mortality and first appropriate and first inappropriate shocks. A multivariable model enforcing a common hazard ratio for sex category across the centres, but allowing for centre-specific baseline hazards and centre specific effects of other covariates, was adjusted for age, the presence of ischaemic cardiomyopathy or a CRT-D, and left ventricular ejection fraction ≤25%. Of the 5033 patients, 957 (19%) were women. During a median follow-up of 33 months (IQR 16-55 months) 129 women (13%) and 807 men (20%) died (HR 0.65; 95% CI: [0.53, 0.79], P-value < 0.0001). An appropriate ICD shock occurred in 66 women (8%) and 514 men (14%; HR 0.61; 95% CI: 0.47-0.79; P = 0.0002). Conclusion Our retrospective analysis of 14 local registries in 11 European countries demonstrates that fewer women than men undergo ICD implantation for primary prevention. After multivariate adjustment, women have a significantly lower mortality and receive fewer appropriate ICD shocks.read more
Citations
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2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death.
Katja Zeppenfeld,Jacob Tfelt-Hansen,Marta de Riva,Bo Gregers Winkel,Elijah R. Behr,Nico A. Blom,Philippe Charron,Domenico Corrado,Nikolaos Dagres,Christian de Chillou,Lars Eckardt,Tim Friede,Kristina H. Haugaa,Mélèze Hocini,Pier D. Lambiase,Eloi Marijon,José L. Merino,Petr Peichl,Silvia G. Priori,Tobias Reichlin,Jeanette Schulz-Menger,Christian Sticherling,Stylianos Tzeis,Axel Verstrael,Maurizio Volterrani +24 more
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Sex differences in cardiac arrhythmia: a consensus document of the European Heart Rhythm Association, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm Society.
Cecilia Linde,Maria Grazia Bongiorni,Ulrika Birgersdotter-Green,Anne B. Curtis,Isabel Deisenhofer,Tetsushi Furokawa,Anne M. Gillis,Kristina H. Haugaa,Kristina H. Haugaa,Gregory Y.H. Lip,Gregory Y.H. Lip,Isabelle C. Van Gelder,Marek Malik,Jeannie Poole,Tatjana S. Potpara,Irina Savelieva,Andrea Sarkozy +16 more
TL;DR: This year's conference was attended by HRS representatives from around the world, as well as representatives of EHRA, E.H.R.A., Serbia, Japan, and The Netherlands.
Journal ArticleDOI
Sex Differences in Advanced Heart Failure Therapies.
TL;DR: This in-depth review of sex differences in advanced heart failure therapy summarizes the existing literature on implantable cardioverter defibrillators, biventricular pacemakers, mechanical circulatory support, and transplantation with a focus on utilization, efficacy/clinical effectiveness, adverse events, and controversies.
Journal ArticleDOI
Clinical effectiveness of primary prevention implantable cardioverter-defibrillators: results of the EU-CERT-ICD controlled multicentre cohort study.
Markus Zabel,Rik Willems,Andrzej Lubiński,Axel Bauer,Axel Bauer,Josep Brugada,David Conen,David Conen,Panagiota Flevari,Gerd Hasenfuß,Martin Svetlosak,Heikki V. Huikuri,Marek Malik,Nikola Pavlović,Georg Schmidt,Rajevaa Sritharan,Simon Schlögl,Janko Szavits-Nossan,Vassil Traykov,Anton E. Tuinenburg,Stefan N. Willich,Markus Harden,Tim Friede,Jesper Hastrup Svendsen,Jesper Hastrup Svendsen,Christian Sticherling,Béla Merkely,Eu-Cert-Icd Investigators +27 more
TL;DR: In contemporary ICM/DCM patients (LVEF ≤35%, narrow QRS), primary prophylactic ICD treatment was associated with a 27% lower mortality after adjustment, and there appear to be patients with less survival advantage, such as older patients or diabetics.
Journal ArticleDOI
Association Between Use of Primary-Prevention Implantable Cardioverter-Defibrillators and Mortality in Patients With Heart Failure: A Prospective Propensity Score-Matched Analysis From the Swedish Heart Failure Registry.
B. Schrage,B. Schrage,Alicia Uijl,Alicia Uijl,Lina Benson,Dirk Westermann,Marcus Ståhlberg,Davide Stolfo,Ulf Dahlström,Cecilia Linde,Frieder Braunschweig,Gianluigi Savarese +11 more
TL;DR: In a contemporary HFrEF population, ICD for primary prevention was underused although it was associated with reduced short- and long-term all-cause mortality, consistent across all the investigated subgroups.
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TL;DR: In patients with a prior myocardial infarction and advanced left ventricular dysfunction, prophylactic implantation of a defibrillator improves survival and should be considered as a recommended therapy.
Journal ArticleDOI
Amiodarone or an implantable cardioverter-defibrillator for congestive Heart failure
Gust H. Bardy,Kerry L. Lee,Daniel B. Mark,Jeanne E. Poole,Douglas L. Packer,Robin Boineau,Michael J. Domanski,Charles Troutman,Jill Anderson,Steven McNulty,Nancy E. Clapp-Channing,Linda Davidson-Ray,Elizabeth S. Fraulo,Daniel P. Fishbein,Richard M. Luceri,John Ip +15 more
TL;DR: In patients with NYHA class II or III CHF and LVEF of 35 percent or less, amiodarone has no favorable effect on survival, whereas single-lead, shock-only ICD therapy reduces overall mortality by 23 percent.
Journal ArticleDOI
Cardiac-resynchronization therapy for the prevention of heart-failure events.
TL;DR: CRT combined with ICD decreased the risk of heart-failure events in relatively asymptomatic patients with a low ejection fraction and wide QRS complex and was associated with a significant reduction in left ventricular volumes and improvement in the ejectedion fraction.
Journal ArticleDOI
Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure
Lars Køber,Jens Jakob Thune,Jens Jakob Thune,Jens Nielsen,Jens Nielsen,Jens Haarbo,Jens Haarbo,Lars Videbæk,Eva Korup,Jensen G,Per Hildebrandt,Flemming Hald Steffensen,Niels Eske Bruun,Niels Eske Bruun,Niels Eske Bruun,Hans Eiskjær,Hans Eiskjær,Axel Brandes,Anna Margrethe Thøgersen,Finn Gustafsson,Kenneth Egstrup,Regitze Videbæk,Christian Hassager,Jesper Hastrup Svendsen,Dan Eik Høfsten,Christian Torp-Pedersen,S. Pehrson +26 more
TL;DR: In this trial, prophylactic ICD implantation in patients with symptomatic systolic heart failure not caused by coronary artery disease was not associated with a significantly lower long-term rate of death from any cause than was usual clinical care.
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