Sex disparities in the choice of cardiac resynchronization therapy device utilized: an analysis of trends, predictors and outcomes.

Rashid; Mamas

Abstract

Background
There is limited evidence on the influence of sex on the decision to implant a cardiac resynchronization therapy device with pacemaker (CRT-P) or defibrillator (CRT-D) and the existence of sex-dependent differences in complications that may affect this decision.
Methods
All patients undergoing de novo CRT implantation (2004-2014) in the United States National Inpatient Sample were included and stratified by device type (CRT-P and CRT-D). Multivariable logistic regression models were conducted to assess the association of female sex with receipt of CRT-D and periprocedural complications.
Results
Out of 400,823 weighted CRT procedural records, the overall percentages of women undergoing CRT-P and CRT-D implantations were 41.5% and 27.8%, respectively, and these percentages increased compared with men over the study period. Women were less likely to receive CRT-D (odds ratio 0.66, 95% confidence interval 0.64-0.67), and this trend remained stable throughout the study period ( P = 0.06). Furthermore, compared with men, women were associated with increased odds of procedure-related complications (bleeding, thoracic, and cardiac) in the CRT-D group but not in the CRT-P group. Factors such as atrial fibrillation, malignancies, renal failure, advanced age (> 60 years), and admission to nonurban/small hospitals favoured the receipt of CRT-P over CRT-D, whereas history of ischemic heart disease, cardiac arrest ,or ventricular arrhythmias favoured the receipt of CRT-D over CRT-P.
Conclusions
Women were associated with persistently reduced odds of receipt of CRT-D compared with men over an 11-year period. This study identifies important factors that predict the choice of CRT device offered to patients in the United States.

Citation

Rashid, & Mamas. (2021). Sex disparities in the choice of cardiac resynchronization therapy device utilized: an analysis of trends, predictors and outcomes. Canadian Journal of Cardiology, 86-93. https://doi.org/10.1016/j.cjca.2020.02.073

• Acceptance Date: Feb 9, 2020
• Publication Date: Jan 1, 2021
• Journal: Canadian Journal of Cardiology
• Print ISSN: 0828-282X
• Publisher: Elsevier
• Pages: 86-93
• DOI: https://doi.org/10.1016/j.cjca.2020.02.073
• Keywords: cardiac resynchronization, pacemaker, defibrillator, sex trends, outcomes
• Publisher URL: http://doi.org/10.1016/j.cjca.2020.02.073