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. 2025 May;21(6):365-370.
doi: 10.1080/14796678.2025.2484958. Epub 2025 Mar 30.

Do gender differences persist in ICD implantation in patients with acute on chronic heart failure?

Jude ElSaygh  1   2 , Laura Bradel  2 , Kevin Pink  2 , Lu Chen  2 , Jonathan Arnedo  2 , Bharath Reddy  2 , Brian Wong  2 , Jeremy Berman  2 , Stephen J Peterson  1   2 , Wilber S Aronow  3   4 , Gioia Turitto  2
Affiliations

Do gender differences persist in ICD implantation in patients with acute on chronic heart failure?

Jude ElSaygh et al. Future Cardiol. 2025 May.

Abstract

Background: Implantable Cardiac Defibrillators (ICDs) prolong survival in patients with heart failure with reduced ejection fraction (HFrEF). Despite strong data suggesting their benefit, there is concern for disparities related to ICD implantation rates.

Methods: A retrospective analysis of 551 patients admitted to a single tertiary institution from June 2020 to May 2023, who met the guideline criteria for ICD implantation for primary prevention of sudden cardiac death, was carried out.

Results: Our population constituted of 56% African Americans, 20% Caucasians, 1% Asians and 2% Native Americans. Of those patients, 47% (157/337) of males and 33% (71/213) of females underwent ICD implantation before discharge, creating a statistically significant gender difference at p = 0.007. Patients aged 50 or greater (218/509) were more likely to receive an ICD compared to younger patients (10/41) at p = 0.000. Of those offered an ICD, 46% deferred to outpatient, 30% refused, and 8% of patient had history of noncompliance, were medically unstable, or were undecided.

Conclusion: Females and younger patients were less likely to have an ICD at discharge. Despite strong recommendations for ICD implantation in eligible patients, most patients did not receive an ICD. This study showcases the limited access to care and highlights potential avenues of improvement.

Keywords: Implantable Cardiac Defibrillators; electrophysiology; gender differences; health equity; heart failure.

Plain language summary

Heart failure is a serious condition that affects millions of people, and implantable cardioverter-defibrillators (ICDs) are used to help prevent sudden cardiac death in these patients. ICDs are recommended for certain heart failure patients, but studies have shown that women are less likely than men to receive them. This study looked at the use of ICDs in patients hospitalized for heart failure at a large hospital in New York City. We found that women and younger patients were less likely to receive an ICD, even though guidelines recommend it for eligible patients. The main reasons for not receiving an ICD were patient refusal and doctors deferring the procedure to outpatient care. Additionally, factors like anxiety, body image concerns, and the shortage of specialized doctors contribute to these disparities. Improving access to care, better patient education, and addressing the gender gap in healthcare providers could help ensure more equitable treatment for all heart failure patients.

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Conflict of interest statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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