Affiliation:
1. Aston Medical Research Institute Aston Medical School Aston University Birmingham United Kingdom
2. Quality and Outcomes Research Unit Queen Elizabeth Hospital Birmingham United Kingdom
3. NHS Digital and Farr Institute London United Kingdom
4. Electrophysiology and Pacing Unit Humanitas Research Hospital IRCCS Rozzano‐Milano Italy
Abstract
Background
Women are underrepresented in cardiac resynchronization therapy (
CRT
) trials. Some studies suggest that women fare better than men after
CRT
. We sought to explore clinical outcomes in women and men undergoing
CRT
‐defibrillation or CRT‐pacing in real‐world clinical practice.
Methods and Results
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 years, interquartile range, 1–4 years). In analysis of the total population, the primary end point of total mortality (adjusted hazard ratio [
aHR
], 0.73; 95% CI, 0.69–0.76) and the secondary end point of total mortality or heart failure hospitalization (
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 heart failure hospitalization (
aHR
, 0.79; 95% CI, 0.75–0.82) were lower for
CRT
‐defibrillation than for
CRT
‐pacing. 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
‐defibrillation in women (
aHR
, 0.83;
P
=0.013) and men (
aHR
, 0.69;
P
<0.001).
Conclusions
Compared with men, women lived longer and were less likely to be hospitalized for heart failure after
CRT
. In both sexes,
CRT
‐defibrillation was superior to
CRT
‐pacing with respect to survival and heart failure hospitalization. The longest survival after
CRT
was observed in women without a history of myocardial infarction.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
12 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献