Key result
Female sex is linked to ~18% higher likelihood of undergoing septal reduction therapy.
Why the study?
Data were limited examining potential sex-based disparities in the utilization and complications of septal reduction therapy in patients with obstructive hypertrophic cardiomyopathy.
Does patient sex affect the utilization and in-hospital outcomes of septal reduction therapy in adults hospitalized with obstructive hypertrophic cardiomyopathy?
Cohort (n=72,680)
Yes
Does patient sex affect the utilization and in-hospital outcomes of septal reduction therapy in adults hospitalized with obstructive hypertrophic cardiomyopathy?
In a large US inpatient cohort of obstructive HCM, female patients were slightly more likely to undergo septal reduction therapy—particularly alcohol septal ablation—after risk adjustment, and experienced similar in-hospital mortality and major complication rates compared to males, but had higher rates of pacemaker implantation and lower rates of ICD implantation.
Answers are grounded in this paper and cite their sources.
Potential sex differences in obstructive HCM procedural care merit equity review; leaves open mechanisms and outcome impact.
Background: Data are limited that examine potential sex-based disparities in the utilization and complications of septal reduction therapy (SRT) in patients with obstructive hypertrophic cardiomyopathy. Our aim was to assess the use and in-hospital outcomes of SRT, according to sex. We performed a retrospective cohort study using the 2017-2019 National Inpatient Sample database. Adult patients with obstructive hypertrophic cardiomyopathy were identified. Methods: We assessed the use of SRT (surgical septal myectomy and alcohol septal ablation), according to sex. In those who underwent SRT, rates of in-hospital mortality, pacemaker implantation, implantable cardioverter defibrillator (ICD) implantation, ischemic stroke, major bleeding, and pericardial complication were assessed. All outcomes were compared between groups using inverse probability of treatment weighting (IPTW), adjusting for demographics, comorbidity burden, and hospital characteristics. Results: In total, 72,680 weighted hospitalizations (median age: 67 years [range: 57-77]; 61% female patients) were included, and only 5.9% of patients underwent SRT. After IPTW adjustment, female patients were more likely to undergo SRT (adjusted risk ratio [aRR] 1.18, 95% confidence interval [95% CI] 1.03-1.36) and alcohol septal ablation (aRR 1.38, 95% CI 1.04-1.83). Likewise, female patients received pacemaker implantation more often (aRR 1.96, 95% CI 1.10-3.50) and ICD implantation (aRR 0.58, 95% CI 0.34-0.99) less frequently, compared with male patients. No differences were present in rates of surgical septal myectomy, in-hospital mortality, ischemic stroke, major bleeding, and pericardial complication between groups. Conclusions: Our results suggest that female patients were slightly more likely to undergo SRT, especially alcohol septal ablation. In-hospital mortality and postprocedural complications were similar between the sexes, but women received more pacemaker implantation and less ICD implantation.
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Diaz‐Arocutipa et al. (2024) conducted a cohort in Obstructive hypertrophic cardiomyopathy (n=72,680). Female sex vs. Male sex was evaluated on Utilization of septal reduction therapy (surgical septal myectomy or alcohol septal ablation) (aRR 1.18, 95% CI 1.03-1.36, p=0.016). Female sex was associated with a higher adjusted likelihood of undergoing septal reduction therapy and pacemaker implantation, but lower ICD implantation.
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