The Gender-Paradox among Patients with Implantable Cardioverter-Defibrillators: A Propensity-Matched Study

Autor:	Vamsimohan Pavuluri, Danette Guertin, J. Kluger, Christopher A. Clyne, Sanjeev P. Bhavnani, Craig I Coleman, Ravi K. Yarlagadda
Rok vydání:	2013
Předmět:	medicine.medical_specialty Ejection fraction Proportional hazards model business.industry medicine.medical_treatment Hazard ratio Cardiomyopathy General Medicine medicine.disease Implantable cardioverter-defibrillator Confidence interval Internal medicine Cohort Cardiology Medicine Population study Cardiology and Cardiovascular Medicine business
Zdroj:	Pacing and Clinical Electrophysiology. 36:878-884
ISSN:	0147-8389
DOI:	10.1111/pace.12141
Popis:	Background Several meta-analyses of the implantable cardioverter-defibrillator (ICD) clinical trials have demonstrated that while men derived a mortality reduction with prophylactic ICD implantation, women did not. These trials also observed that women receive less appropriate ICD shock therapy compared to men. We aimed to investigate this "gender-paradox" among a heterogeneous community cohort of patients receiving ICDs. Methods We identified 1,445 consecutive patients undergoing ICD implantation from 1997 to 2007. The study population consisted of 582 patients, of whom 291 were women who could be propensity matched to 291 men, based on age, ejection fraction, implantation indication (primary or secondary), etiology of cardiomyopathy (ischemic or nonischemic), and the presence of a cardiac resynchronization therapy-defibrillator (CRT-D) device. The impact of gender difference on the probability of death and appropriate ICD shocks for ventricular arrhythmias was calculated using multivariable Cox proportional hazards analyses. Results During a mean follow-up of 909 ± 901 days, compared to men, women demonstrated a similar risk of death (25% vs 25%, adjusted hazard ratio [AHR] 1.05 [95% confidence interval (CI) 0.81-1.35], P = 0.74). In contrast, women demonstrated a decreased probability of appropriate ICD-shock therapy (14% vs 19%, AHR 0.80 [95% CI 0.59-0.88], P = 0.03) compared to men, and among cohorts with a nonischemic cardiomyopathy (10% vs 20%, P Conclusion Among a community cohort with ICDs, women have a similar mortality compared to men while experiencing less appropriate ICD therapy. These results support the findings of a lower arrhythmic mortality among women.
Databáze:	OpenAIRE
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