Impact of sex on the utilization of defibrillation-capable cardiac implantable devices and outcome: results from the German device registry

Abstract Background and aims Implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy with defibrillation-function (CRT-D) are widely used in patients with life-threatening arrhythmias or heart failure. We aim to investigate the impact of sex-specific differences on defibrillation-capable cardiac devices’ implantation and outcomes. Methods The German DEVICE registry is a prospective, multicentre database of ICD and CRT device implantation. A total of 5330 patients receiving a defibrillation-capable device were prospectively enrolled in 44 centres between March 2007 and February 2014 and followed for 17 (13, 23) months. Results A minority of patients in this registry was female 1017 (19.1%). The rate of CRT-D use among the defibrillator recipients was higher in women (32.4% vs. 28.0%; p = 0.006). The incidence of major periprocedural complications and in-hospital complications were higher in women (3.3% vs. 1.6%; p = 0.001 and 5.5% vs. 3.6%; p = 0.017, respectively). The 1-year all-cause mortality was 5.5% for women and 7.4% for men ( p = 0.039), while the 1-year cardiovascular mortality was 4.1% and 6.2%, respectively ( p = 0.012). Less women received device shocks during 1-year follow-up (10.7% vs. 13.8%; p = 0.023). Women receiving CRT-D had a lower non-device-related cardiovascular hospitalization rate than men. System revision until discharge, in-hospital death and non-fatal complications during follow-up were comparable for men and women. Similar rates of all-cause and cardiac rehospitalizations were found. Conclusions In this real-life patient cohort only a minority of patients was female. Female patients had a higher risk of major periprocedural complications and in-hospital complications but a lower all-cause and cardiovascular mortality. Less women experienced device-shocks during follow-up. Graphical Abstract Overview of the results