Underrepresentation of women in implantable cardioverter defibrillator trials

Figures

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  Fig. 1. Sex Differences in Mortality in SCD-HeFT. This figure includes subjects enrolled in all three arms of the trial, including placebo, amiodarone, and ICD therapy groups. Overall mortality was lower in women (20.9%) than in men (28.1%), HR 0.68 (CI 0.55,0.84, P = 0.001) in SCD-HeFT. Lower mortality was seen in women in the placebo group (21.4% vs. 31.0%, women vs. men, HR 0.67 (CI 0.46,0.98, P = 0.037) with a trend in the amiodarone group (22.3% vs. 30.6%, women vs. men, HR 0.71 (CI 0.50,1.01, P = 0.059). There was no difference in mortality between women and men in the ICD group (18.9% vs. 22.8%, women vs. men, HR 0.88 (CI 0.58,1.32, P = 0.52)). Hazard ratio for women vs. men from Cox proportional hazards model adjusted for randomized treatment, HF etiology, NYHA class, age, race, weight, pulmonary disease, lipids, AF, NSVT, syncope, BP, pulse, Na, and creatinine [26].

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  Fig. 2. Meta-analysis of primary prevention trials with outcomes of women versus men. The hazard ratios of overall morality (A) and appropriate ICD interventions (B) are shown. While overall mortality did not differ in men versus women in the meta-analysis, women were less likely to receive appropriate ICD therapy for ventricular arrhythmias than men [29].

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  Fig. 3. Author sex and representation of female participants in primary and secondary prevention ICD trials, 1996–2016. Proportion of male (blue) authors, female (red) authors and female participants (yellow) per trial is show in percent of total authors and total participants per trial. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

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  Fig. 4. Identification of gaps and potential ways to improve diversity, equity and inclusion in electrophysiology trials.

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  Fig. 5. Summary of sex differences in ICD therapy.