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Sticherling C, Arendacka B, Svendsen JH, Wijers S, Friede T, Stockinger J, Dommasch M, Merkely B, Willems R, Lubinski A, Scharfe M, Braunschweig F, Svetlosak M, Zürn CS, Huikuri H, Flevari P, Lund-Andersen C, Schaer BA, Tuinenburg AE, Bergau L, Schmidt G, Szeplaki G, Vandenberk B, Kowalczyk E, Eick C, Juntilla J, Conen D, Zabel M. Sex differences in outcomes of primary prevention implantable cardioverter-defibrillator therapy: combined registry data from eleven European countries. Europace 2018; 20:963-970. [PMID: 29016784 PMCID: PMC5982785 DOI: 10.1093/europace/eux176] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 04/27/2017] [Indexed: 12/29/2022] Open
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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Affiliation(s)
- Christian Sticherling
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Barbora Arendacka
- University Medical Center, Department of Cardiology and Pneumology, Robert-Koch-Str.40, Göttingen 37075, Germany
| | - Jesper Hastrup Svendsen
- Rigshospitalet, University of Copenhagen, Copenhagen, RHC, Blegdamsvej 9, Copenhagen OE 2100, Denmark
| | - Sofieke Wijers
- University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Tim Friede
- University Medical Center, Department of Cardiology and Pneumology, Robert-Koch-Str.40, Göttingen 37075, Germany
| | - Jochem Stockinger
- Universitäts Herzzentrum Freiburg-Bad Krozingen, Klinik für Kardiologie, Südring 15, 79185 Bad Krozingen, Germany
| | - Michael Dommasch
- Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany
| | - Bela Merkely
- Semmelweiss University Heart Center, Varosmajor 68, Budapest 1122, Hungary
| | - Rik Willems
- University of Leuven, Herestraat 49, Leuven 3000, Belgium
| | | | - Michael Scharfe
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Frieder Braunschweig
- Karolinska Institutet, Department of Cardiology, Solna, Karolinska University Hospital, Solnavägen1, Stockholm 17176, Sweden
| | - Martin Svetlosak
- Slovak Medical University Limbova 12, Bratislava 83303, Slovakia
| | - Christine S Zürn
- Eberhards Karls Universität Tübingen, Otfried-Müller- Str. 10, 72070 Tübingen, Germany
| | - Heikki Huikuri
- University of Oulu, Institute of Clinical Medicine, Kajaanintie 50, PO Box 5000, Oulu 90014, Finland
| | | | - Caspar Lund-Andersen
- Rigshospitalet, University of Copenhagen, Copenhagen, RHC, Blegdamsvej 9, Copenhagen OE 2100, Denmark
| | - Beat A Schaer
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Anton E Tuinenburg
- University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Leonard Bergau
- University Medical Center, Department of Cardiology and Pneumology, Robert-Koch-Str.40, Göttingen 37075, Germany
| | - Georg Schmidt
- Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany
| | - Gabor Szeplaki
- Semmelweiss University Heart Center, Varosmajor 68, Budapest 1122, Hungary
| | | | | | - Christian Eick
- Eberhards Karls Universität Tübingen, Otfried-Müller- Str. 10, 72070 Tübingen, Germany
| | - Juhani Juntilla
- University of Oulu, Institute of Clinical Medicine, Kajaanintie 50, PO Box 5000, Oulu 90014, Finland
| | - David Conen
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Markus Zabel
- University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
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