Sex disparities in the use and outcomes of septal reduction therapies for obstructive hypertrophic cardiomyopathy

Diaz-Arocutipa, Carlos; Moreno, Guillermo; Giráldez, Manuel; Hernandez, Adrian V.; Mamas, Mamas A.; Vicent, Lourdes

Abstract

Background
There is limited data examining potential sex-based disparities in the utilization and complications of septal reduction therapy (SRT) in patients with obstructive hypertrophic cardiomyopathy (HCM). Our aim was to assess the use and in-hospital outcomes of SRT according to sex. We performed a retrospective cohort study using the 2017-2019 National Inpatient Sample database. Adult patients with obstructive HCM were identified.

Methods
We assessed the use of SRT (surgical septal myectomy and alcohol septal ablation) according to sex. In those who underwent SRT, in-hospital mortality, pacemaker implantation, implantable cardioverter defibrillator (ICD) implantation, ischemic stroke, major bleeding, and pericardial complication were assessed. All outcomes were compared between groups using inverse probability of treatment weighting (IPTW), adjusting for demographics, comorbidity burden, and hospital characteristics.

Results
In total, 72,680 weighted hospitalizations (median age 67 [57-77] years, 61% female) were included, with only 5.9% of patients underwent SRT. After IPTW adjustment, females were more likely to undergo SRT (adjusted risk ratio [aRR] 1.18, 95% confidence interval [95% CI] 1.03-1.36) and alcohol septal ablation (aRR 1.38, 95% CI 1.04-1.83). Likewise, females received more often pacemaker implantation (aRR 1.96, 95% CI 1.10-3.50) and ICD (aRR 0.58, 95% CI 0.34-0.99) less frequently. There were no differences in surgical septal myectomy, in-hospital mortality, ischemic stroke, major bleeding, and pericardial complication between groups.

Conclusions
Our results suggest that females were slightly more likely to undergo SRT, especially alcohol septal ablation. In-hospital mortality and post-procedural complications were similar between sexes, but women received more pacemaker and less ICD implantation.

Citation

Diaz-Arocutipa, C., Moreno, G., Giráldez, M., Hernandez, A. V., Mamas, M. A., & Vicent, L. (2024). Sex disparities in the use and outcomes of septal reduction therapies for obstructive hypertrophic cardiomyopathy. CJC Open, https://doi.org/10.1016/j.cjco.2024.05.013

• Journal Article Type: Article
• Acceptance Date: May 27, 2024
• Online Publication Date: Jun 3, 2024
• Publication Date: Jun 3, 2024
• Deposit Date: Jun 18, 2024
• Journal: CJC Open
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1016/j.cjco.2024.05.013
• Keywords: hypertrophic cardiomyopathysexleft ventricular outflow tract obstructionseptal reduction therapysurgical septal myectomyalcohol septal ablation
• Public URL: https://keele-repository.worktribe.com/output/847590
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S2589790X24002257?via%3Dihub