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

Rashid; Mamas

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


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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.

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

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