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Cardiovascular disease (CVD) continues to be the primary cause of mortality and morbidity globally with middle-aged women presenting with additional and possibly, overlooked risk factors.1 Despite several awareness programmes, there remain several gaps in the political education and representation needs of this group, which includes those from low socioeconomic status (SES) and culturally diverse backgrounds. These […]

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75/Sex-specific differences in survival and heart failure hospitalisation after cardiac resynchronisation therapy with or without defibrillation

F Leyva (Presenting Author) - Aston University, Birmingham, UK; T Qiu - Aston University, Birmingham, UK; A Zegard - Aston University, Birmingham, UK; O Okafor - Aston University, Birmingham, UK; D McNulty - Queen Elizabeth Hospital, Birmingham, UK; F Evison - Queen Elizabeth Hospital, Birmingham, UK; Ray - NHS Digital and Farr Institute, London, UK; M Gasparini - Electrophysiology and Pacing Unit, Humanitas Research Hospital IRCCS, Milan, Italy
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Published Online: Oct 3rd 2008 European Journal of Arrhythmia & Electrophysiology. 2019;5(Suppl. 1):abstr75
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Article

Background: Women are underrepresented in cardiac resynchronisation therapy (CRT) trials. Some studies suggest that women fare better than men after CRT.

Objectives: To explore clinical outcomes in women and men undergoing CRT-defibrillation (CRT-D) or -pacing (CRT-P) in real-world clinical practice.

Methods: A national database (Hospital Episode Statistics for England) was used to quantify clinical outcomes in 43,730 patients (women: 10,890 [24.9%], men: 32,840 [75.1%]) undergoing CRT over 7.6 years, (median follow-up 2.2 yrs, interquartile range, 1–4 yrs).

Results: In analysis of the total population, the primary endpoint of total mortality (adjusted hazard ratio [aHR]: 0.73, 95% confidence interval [CI] 0.69–0.76) and the secondary endpoint of total mortality or HF hospitalisation (aHR: 0.79, 95% CI 0.75–0.82) were lower in women, independent of known confounders. Total mortality (aHR: 0.73, 95% CI 0.70–0.76) and total mortality or HF hospitalisation (aHR: 0.79, 95% CI 0.75–0.82) were lower for CRT-D than for CRT-P. In analyses of patients with (aHR:0.89, 95% CI 0.80–0.98) or without (aHR:0.70, 95%CI 0.66–0.73) a myocardial infarction, women had a lower total mortality. In sex-specific analyses, total mortality was lower after CRT-D in women (aHR: 0.83, p=0.013) and men (aHR: 0.69, p<0.001).

 

Conclusions: Compared to men, women lived longer and were less likely to be hospitalised for HF after CRT. In both sexes, CRT-D was superior to CRT-P with respect to survival and HF hospitalisation. The longest survival after CRT was observed in women without a history of MI.

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