Cardiac Resynchronization Therapy in Women Versus Men
Key result
Among patients with LBBB, CRT-D was associated with a lower mortality risk than ICD in women (HR 0.74; 95% CI 0.68-0.81) and men (HR 0.84; 95% CI 0.79-0.89), with greater benefit in women.
Why the study?
Does cardiac resynchronization therapy-defibrillator (CRT-D) reduce death risk compared to implantable cardioverter defibrillator (ICD) in patients with NYHA class III/IV heart failure, reduced LVEF, and prolonged QRS duration?
Population
75,079 patients with New York Heart Association class III or IV heart failure, reduced left ventricular…
Comparison
Cardiac resynchronization therapy-defibrillator vs Implantable cardioverter defibrillator (ICD)
Design
Cohort
Authors
Discussion
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Member takes
Implication
Greater CRT-D mortality benefit in women with LBBB; hypothesis-generating and requires randomized confirmation before practice change.
Study Design
Type
Cohort (n=75,079)
Structured PICO
Does cardiac resynchronization therapy-defibrillator (CRT-D) reduce death risk compared to implantable cardioverter defibrillator (ICD) in patients with NYHA class III/IV heart failure, reduced LVEF, and prolonged QRS duration?
P
Population
75,079 patients with NYHA class III or IV heart failure, reduced LVEF, and prolonged QRS duration (≥120 ms) receiving either CRT-D or ICD.
E
Exposure
Cardiac resynchronization therapy-defibrillator (CRT-D)
C
Comparator
Implantable cardioverter defibrillator (ICD)
O
Outcome
Death risk (mortality)hard clinical
Main Result
Hazard Ratio: 0.74 (95% CI 0.68–0.81)
Absolute Risk Reduction: 11%
In a large real-world cohort, CRT-D was associated with a greater mortality reduction in women than in men among patients with LBBB, while benefits were attenuated in both sexes without LBBB.
Cite This Study
Zusterzeel et al. (2015) conducted a cohort in Heart failure with reduced ejection fraction and prolonged QRS duration (n=75,079). Cardiac resynchronization therapy-defibrillators (CRT-D) vs. Implantable cardioverter defibrillator (ICD) was evaluated on Death risk (HR 0.74, 95% CI 0.68-0.81). Among patients with LBBB, CRT-D was associated with a lower mortality risk than ICD in women (HR 0.74; 95% CI 0.68-0.81) and men (HR 0.84; 95% CI 0.79-0.89), with greater benefit in women.