Key result
Cardiac resynchronization therapy was associated with lower all-cause death in female patients, whereas other outcomes did not significantly differ by sex, race, or age.
Why the study?
Most CRT RCTs showing survival benefits primarily enrolled older white men, leaving efficacy across sex, race, and age unclear.
Does the efficacy of cardiac resynchronization therapy (CRT) on cardiovascular outcomes differ by sex, race, and age in adult patients?
Meta-Analysis
Does the efficacy of cardiac resynchronization therapy (CRT) on cardiovascular outcomes differ by sex, race, and age in adult patients?
This meta-analysis highlights a significant gap in reporting CRT outcomes by demographic subgroups, while suggesting a potential survival advantage for female patients receiving CRT.
BACKGROUND: Cardiac resynchronization therapy (CRT) is beneficial in patients who have heart failure with reduced ejection fraction or arrhythmic events. However, most randomized controlled trials (RCTs) showing survival benefits primarily enrolled older white men. This study aims to evaluate CRT efficacy by sex, race, and age in RCTs. METHODS: Five electronic databases (CINAHL, Embase, Emcare, Medline, and PubMed) were searched from inception to July 12, 2021 for RCTs with CRT in adult patients. Data were analyzed for clinical outcomes including all-cause or cardiovascular (CV) death, worsening heart failure (HF), and HF hospitalization (HFH) according to sex, race, and age. RESULTS: = 0.55) among ≥ 65 versus < 65 years. CONCLUSIONS: Whereas all-cause death was lower in female CRT patients, other reported outcomes did not significantly differ by sex, race, or age. Only 6 studies partially reported outcomes. Thus, enhanced reporting and analyses are required to overcome such paucity of data to evaluate the impact of these factors on clinical outcomes in distinct patient cohorts with CRT indication.
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McKay et al. (2021) conducted a meta-analysis in Heart failure with reduced ejection fraction or arrhythmic events. Cardiac resynchronization therapy (CRT) was evaluated on All-cause or cardiovascular (CV) death, worsening heart failure (HF), and HF hospitalization (HFH). Cardiac resynchronization therapy was associated with lower all-cause death in female patients, whereas other outcomes did not significantly differ by sex, race, or age.
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