July 3, 2026Journal of the American College of Cardiology
Cardiac Resynchronization Therapy Is More Effective in Women Than in Men
Key result
CRT-D cuts death or heart failure ~69% vs ICD in women, driving greater reverse remodeling.
- HR 0.31
- P<0.001
- n=1,820
Why the study?
In the MADIT-CRT trial, women appeared to achieve better outcomes from resynchronization therapy than men, prompting an investigation into factors related to sex-specific death and heart failure events.
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
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“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.”
“To our knowledge, this is the first major study to show this greater benefit in women. Women have made up only 5–8% of the population in most previous trials. We had the forethought to include 25% in our trial.”
“This is important because different professional societies recently have recommended that CRT be given to patients with QRS duration of 150 msec or more, and primarily in class II heart failure. However, this cutoff would exclude women with left bundle branch block and QRS duration 130-149 msec that derived significant benefit in MADIT-CRT.”
Implication
May support sex-specific CRT considerations in HF; hypothesis-generating and should not yet change practice.
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).
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Cite This Study
Arshad et al. (2011) conducted an RCT in Heart failure (n=1,820). Cardiac resynchronization therapy with defibrillator (CRT-D) vs. Implanted cardioverter-defibrillator (ICD) was evaluated on death or heart failure (whichever came first) (HR 0.31, p=<0.001). 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.