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Multicenter Study
. 2018 Jun 1;20(6):963-970.
doi: 10.1093/europace/eux176.

Sex differences in outcomes of primary prevention implantable cardioverter-defibrillator therapy: combined registry data from eleven European countries

Christian Sticherling  1 , Barbora Arendacka  2 , Jesper Hastrup Svendsen  3 , Sofieke Wijers  4 , Tim Friede  2 , Jochem Stockinger  5 , Michael Dommasch  6 , Bela Merkely  7 , Rik Willems  8 , Andrzej Lubinski  9 , Michael Scharfe  1 , Frieder Braunschweig  10 , Martin Svetlosak  11 , Christine S Zürn  12 , Heikki Huikuri  13 , Panagiota Flevari  14 , Caspar Lund-Andersen  3 , Beat A Schaer  1 , Anton E Tuinenburg  4 , Leonard Bergau  2 , Georg Schmidt  6 , Gabor Szeplaki  7 , Bert Vandenberk  8 , Emilia Kowalczyk  9 , Christian Eick  12 , Juhani Juntilla  13 , David Conen  1 , Markus Zabel  4 ; EU-CERT-ICD Investigators
Affiliations
Multicenter Study

Sex differences in outcomes of primary prevention implantable cardioverter-defibrillator therapy: combined registry data from eleven European countries

Christian Sticherling et al. Europace. .

Erratum in

  • Corrigendum.
    [No authors listed] [No authors listed] Europace. 2018 Jun 1;20(6):970. doi: 10.1093/europace/eux348. Europace. 2018. PMID: 29126232 Free PMC article. No abstract available.

Abstract

Aims: Therapy with an implantable cardioverter defibrillator (ICD) is established for the prevention of sudden cardiac death (SCD) in high risk patients. We aimed to determine the effectiveness of primary prevention ICD therapy by analysing registry data from 14 centres in 11 European countries compiled between 2002 and 2014, with emphasis on outcomes in women who have been underrepresented in all trials.

Methods and results: Retrospective data of 14 local registries of primary prevention ICD implantations between 2002 and 2014 were compiled in a central database. Predefined primary outcome measures were overall mortality and first appropriate and first inappropriate shocks. A multivariable model enforcing a common hazard ratio for sex category across the centres, but allowing for centre-specific baseline hazards and centre specific effects of other covariates, was adjusted for age, the presence of ischaemic cardiomyopathy or a CRT-D, and left ventricular ejection fraction ≤25%. Of the 5033 patients, 957 (19%) were women. During a median follow-up of 33 months (IQR 16-55 months) 129 women (13%) and 807 men (20%) died (HR 0.65; 95% CI: [0.53, 0.79], P-value < 0.0001). An appropriate ICD shock occurred in 66 women (8%) and 514 men (14%; HR 0.61; 95% CI: 0.47-0.79; P = 0.0002).

Conclusion: Our retrospective analysis of 14 local registries in 11 European countries demonstrates that fewer women than men undergo ICD implantation for primary prevention. After multivariate adjustment, women have a significantly lower mortality and receive fewer appropriate ICD shocks.

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Figures

Figure 1
Figure 1
Cumulative incidences of all-cause mortality in the cohort and individual centres.
Figure 2
Figure 2
Cumulative incidences of all-cause mortality by gender (with 95% CIs).
Figure 3
Figure 3
Forest plot of estimated centre-specific hazard ratios for gender regarding overall-mortality together with their 95% CIs and the pooled hazard ratio with a modified Knapp-Hartung 95% CI. (Note that not all centres were included in this analysis.). “Abbreviations of the centers can be found in the supplementary material”.
Figure 4
Figure 4
Cumulative incidences of first appropriate shocks in cohort and individual centres.
Figure 5
Figure 5
Cumulative incidences of first appropriate shocks by gender (with 95% CIs).
Figure 6
Figure 6
Forest plot of estimated centre-specific hazard ratios for gender regarding the first appropriate shock together with their 95% CIs and the pooled hazard ratio with a modified Knapp-Hartung 95% CI. (Note that only centres with at least 10 female patients and at least 1 observed first appropriate shock both among males and females were included in this analysis.).
See this image and copyright information in PMC

References

    1. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS. et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002;346:877–83. - PubMed
    1. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R. et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005;352:225–37. - PubMed
    1. Koller MT, Schaer B, Wolbers M, Sticherling C, Bucher HC, Osswald S.. Death without prior appropriate implantable cardioverter-defibrillator therapy: a competing risk study. Circulation 2008;117:1918–26. - PubMed
    1. Lee DS, Hardy J, Yee R, Healey JS, Birnie D, Simpson CS. et al. Clinical risk stratification for primary prevention implantable cardioverter defibrillators. Circ Heart Fail 2015;8:927–37. - PMC - PubMed
    1. Lee DS, Gona P, Albano I, Larson MG, Benjamin EJ, Levy D. et al. A systematic assessment of causes of death after heart failure onset in the community: impact of age at death, time period, and left ventricular systolic dysfunction. Circ Heart Fail 2011;4:36–43. - PMC - PubMed

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