September 13, 2011Journal of Cardiovascular Electrophysiology
Cardiac Resynchronization Therapy: Do Women Benefit More Than Men?
Key result
Female CRT recipients had a lower unadjusted risk of death than men (HR 0.51; 95% CI 0.35-0.75; P<0.001), but multivariate analysis showed this was driven by nonischemic etiology and other factors.
Why the study?
Does cardiac resynchronization therapy provide greater survival and clinical benefit in women compared to men?
Population
728 consecutive patients meeting guidelines for placement of a cardiac resynchronization therapy device.
Comparison
Cardiac resynchronization therapy in female… vs Cardiac resynchronization therapy in male patients
Design
Cohort
Authors
Discussion
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Member takes
Implication
Observed greater CRT benefit in women supports gender-specific research; does not support practice change without randomized confirmation.
Key Points
- This research aims to determine if there are gender differences in the benefits of cardiac resynchronization therapy (CRT).
- Included 728 consecutive CRT recipients meeting guidelines for device placement.
- Collected clinical characteristics and echocardiographic parameters at baseline and after CRT.
- Conducted Kaplan-Meier survival analysis to compare outcomes between genders.
- Female patients had a greater improvement in NYHA class (-0.79 vs -0.56, P = 0.009) compared to males.
- Women had lower mortality risk after CRT (hazard ratio 0.51, 95% CI 0.35-0.75, P < 0.001).
- Multivariate analysis showed independent survival predictors were age, cardiomyopathy cause, NYHA class, and lead location.
Study Design
Type
Cohort (n=728)
Multicenter
No
Structured PICO
Does cardiac resynchronization therapy provide greater survival and clinical benefit in women compared to men?
P
Population
728 consecutive patients who met guidelines for cardiac resynchronization therapy, evaluated for gender differences in clinical improvement and survival.
E
Exposure
Cardiac resynchronization therapy (CRT) in female patients
C
Comparator
Cardiac resynchronization therapy (CRT) in male patients
O
Outcome
Survival (death) and improvement in clinical and echocardiographic parameters (including NYHA class)hard clinical
Main Result
Hazard Ratio: 0.51 (95% CI 0.35–0.75)
p-value: p=<0.001
While women appear to derive greater survival benefit from CRT than men, this difference is primarily driven by a higher prevalence of nonischemic cardiomyopathy and other baseline clinical factors rather than female sex itself.
Cite This Study
XU et al. (2011) conducted a cohort in Heart failure requiring cardiac resynchronization therapy (n=728). Female gender vs. Male gender was evaluated on Death (HR 0.51, 95% CI 0.35-0.75, p=<0.001). Female CRT recipients had a lower unadjusted risk of death than men (HR 0.51; 95% CI 0.35-0.75; P<0.001), but multivariate analysis showed this was driven by nonischemic etiology and other factors.