July 3, 2026
View Full PaperCardiac Resynchronization Therapy Is More Effective in Women Than in Men
Key Result
Among women, CRT-D therapy significantly reduced the risk of death or heart failure compared to ICD therapy (HR 0.31, P<0.001), with greater benefit and reverse cardiac remodeling observed than in men.
Key Points
- This research aims to evaluate the effectiveness of cardiac resynchronization therapy in men versus women.
- Randomized trial comparing outcomes of cardiac resynchronization therapy in male and female patients.
- Assessments of ventricular function and overall heart failure outcomes post-therapy.
- Women exhibited a significant improvement in ventricular function over men (specific metrics not provided).
- Outcomes suggest that women may benefit more from cardiac resynchronization therapy compared to men.
Study Design
Type
RCT (n=1,820)
Multicenter
Yes
PICO
P
Population
1,820 patients (453 female and 1,367 male) from the MADIT-CRT trial analyzed for sex-specific outcomes of CRT-D versus ICD therapy.
I
Intervention / Comparator
Cardiac resynchronization therapy with defibrillator (CRT-D) vs Implanted cardioverter-defibrillator (ICD)
O
Primary Outcome
death or heart failure (whichever came first) — HR 0.31, p=<0.001
Main Result
Hazard Ratio: 0.31
p-value: p=<0.001
Abstract
OBJECTIVES: The purpose of this study was to investigate the factors related to sex-specific outcomes for death and heart failure events in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) trial. BACKGROUND: In the MADIT-CRT trial, women seemed to achieve a better result from resynchronization therapy than men. METHODS: All 1,820 patients (453 female and 1,367 male) enrolled in the MADIT-CRT trial were included in this sex-specific outcome analysis that compared the effect of cardiac resynchronization therapy with defibrillator (CRT-D) relative to implanted cardioverter-defibrillator (ICD) on death or heart failure (whichever came first), heart failure only, and death at any time. RESULTS: Female patients were more likely to have nonischemic cardiomyopathy and left bundle branch block and less likely to have renal dysfunction than male patients. Overall, female patients had a better result from CRT-D therapy than male patients, with a significant 69% reduction in death or heart failure (hazard ratio: 0.31, p < 0.001) and 70% reduction in heart failure alone (hazard ratio: 0.30, p < 0.001). Women had a significant 72% reduction in all-cause mortality in the total population (hazard ratio: 0.28, p = 0.02) and significant 82% and 78% reductions in mortality in those with QRS ≥ 150 ms and with left bundle branch block conduction disturbance, respectively, with sex-by-treatment interactions for mortality reduction significant at p < 0.05 in each of these 3 patient groups. These beneficial CRT-D effects among women were associated with consistently greater echocardiographic evidence of reverse cardiac remodeling in women than in men. CONCLUSIONS: Women in the MADIT-CRT trial obtained significantly greater reductions in death or heart failure (whichever came first), heart failure alone, and all-cause mortality with CRT-D therapy than men, with consistently greater echocardiographic evidence of reverse cardiac remodeling in women than in men. (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy MADIT-CRT; NCT00180271).
Expert Takes7 quotes
1/7
“In prior cardiac studies, men and women generally received similar benefit from preventive medical therapy. Our finding was unexpected, but extremely important because this is the only heart treatment that is clearly better in women than men.”
Arthur J. Moss, Professor of Medicine, University of Rochester Medical CenterUniversity of Rochester Medical Centerauto_pipelineView source