Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Feb 19;139(8):1080-1093.
doi: 10.1161/CIRCULATIONAHA.118.037369.

Sex Differences in Advanced Heart Failure Therapies

Eileen M Hsich  1
Affiliations
Review

Sex Differences in Advanced Heart Failure Therapies

Eileen M Hsich. Circulation. .

Abstract

This in-depth review of sex differences in advanced heart failure therapy summarizes the existing literature on implantable cardioverter defibrillators, biventricular pacemakers, mechanical circulatory support, and transplantation with a focus on utilization, efficacy/clinical effectiveness, adverse events, and controversies. One will learn about the controversies regarding efficacy/clinical effectiveness of implantable cardioverter defibrillators and understand why these devices should be implanted in women even if there are sex differences in appropriate shocks. Individuals will learn about the sex differences with biventricular pacemakers with respect to ventricular remodeling and reduction in heart failure hospitalizations/mortality, as well as, possible mechanisms. We will demonstrate sex differences in heart transplantation and waitlist survival. Despite similar survival for women and men with left ventricular assist devices, there are sex differences in adverse events. These devices do successfully bridge women and men to transplant, yet women are less likely than men to have a left ventricular assist at time of listing and time of transplantation. Finally, one will learn about the concerns regarding poor outcome for men who receive female donor hearts and discover this may not be due to sex, but rather size. More research is needed to better understand sex differences and further improve advanced heart failure therapy for both women and men.

Keywords: congestive heart failure; pacemaker; sex; transplantation; ventricular assist device.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Time to first appropriate or inappropriate Implantable cardioverter defibrillators (ICD) shock for women and men implanted in Ontario, Canada for primary or secondary prevention between February 2007-July 2010. Adapted from MacFadden et al. with permission
Figure 2.
Figure 2.
Sex differences in outcome comparing cardiac resynchronization therapy without an implantable defibrillator (CRT-P) and with an implantable defibrillator (CRT-D) to pharmacologic therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Study. Adapted from Bristow et al. with permission
Figure 3.
Figure 3.
Sex specific response to cardiac resynchronization therapy (CRT) with left bundle branch block (LBBB ) based on QRS duration (left) and QRS duration normalized to left ventricular volume (right). Cohort includes 130 patients at the Cleveland Clinic with a median follow-up of 2 years. Response is defined as an increase in ejection fraction (EF) after CRT. Adapted from Varma et al. with permission
Figure 4.
Figure 4.
Sex-specific survival with pulsatile and continuous flow left ventricular assist devices based on the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) registry from June 23, 2006, and March 31, 2010. Adapted from Hsich et al. with permission
Figure 5.
Figure 5.
Sex differences in heart transplantation based on initial United Network for Organ Sharing (UNOS) Status. Sex-specific cumulative incidence curves were generated for all adults in the Scientific Registry of Transplant Recipients initially listed as (A) UNOS Status 1A, (B) UNOS Status 1B, and (C) UNOS Status 2 between 2004-2015. Adapted from Hsich et al. with permission
Figure 6.
Figure 6.
Sex-specific survival in adult heart transplant recipients. Kaplan-Meier survival curves were derived for women and men in the International Heart and Lung Transplantation (ISHLT) database who underwent heart transplantation between January 1982-June 2015. Adapted from ISHLT Registry with permission
Figure 7.
Figure 7.
Sex-specific Donor/Recipient survival in adult heart transplant patients. Kaplan-Meier survival curves were derived for women and men in the International Heart and Lung Transplantation (ISHLT) database who underwent heart transplantation between January 1982-June 2015. Adapted from ISHLT Registry with permission
See this image and copyright information in PMC

References

    1. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jimenez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O’Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart disease and stroke statistics-2018 update: A report from the american heart association. Circulation. 2018;137:e67–e492 - PubMed
    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr., Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL. 2013. accf/aha guideline for the management of heart failure: A report of the american college of cardiology foundation/american heart association task force on practice guidelines. Circulation. 2013;128:e240–327 - PubMed
    1. Hsich EM, Pina IL. Heart failure in women: A need for prospective data. J Am Coll Cardiol 2009;54:491–498 - PubMed
    1. Curtis LH, Al-Khatib SM, Shea AM, Hammill BG, Hernandez AF, Schulman KA. Sex differences in the use of implantable cardioverter-defibrillators for primary and secondary prevention of sudden cardiac death. JAMA. 2007;298:1517–1524 - PubMed
    1. Hess PL, Hernandez AF, Bhatt DL, Hellkamp AS, Yancy CW, Schwamm LH, Peterson ED, Schulte PJ, Fonarow GC, Al-Khatib SM. Sex and race/ethnicity differences in implantable cardioverter-defibrillator counseling and use among patients hospitalized with heart failure: Findings from the get with the guidelines-heart failure program. Circulation. 2016;134:517–526 - PubMed

Publication types

MeSH terms