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Gender differences in the use of primary prevention ICDs in New Zealand patients with heart failure
  1. Khang-Li Looi1,
  2. Karishma Sidhu1,
  3. Lisa Cooper1,
  4. Liane Dawson2,
  5. Debbie Slipper2,
  6. Andrew Gavin2,
  7. Nigel Lever1
  1. 1 Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
  2. 2 Cardiovascular Division, North Shore Hospital, Auckland, New Zealand
  1. Correspondence to Dr Khang-Li Looi, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, 1023, New Zealand; khanglil{at}adhb.govt.nz

Abstract

Objective Women have been under-represented in randomised clinical trials for primary prevention implantable cardioverter defibrillators (ICDs), and there are concerns about the efficacy of devices between genders. Our study aimed to investigate gender differences in the use of primary prevention ICD in patients with heart failure from the northern region of New Zealand.

Methods Patients with heart failure with systolic dysfunction who received primary prevention ICD/cardiac resynchronisation therapy-defibrillator (CRT-D) in the northern region of New Zealand from 1 January 2007 to 1 June 2015 were included. Complications, mortality and hospitalisation events were reviewed.

Results Of the 385 patients with heart failure implanted with ICD/CRT-D, women comprised 15.1% (n=58), and no change in utilisation of these devices was observed over the study period among women. Women were more likely to have non-ischaemic cardiomyopathy and have higher perioperative complications (8.6% vs 2.5%, P=0.02), with non-significant higher trend towards increased lead displacement (5.2% vs 1.8%, P=0.12). Women appeared to have lower all-cause (10.3% vs 18.7%, P=0.12), cardiovascular (5.2% vs 11.9%, P=0.13) and heart failure (3.5% vs 7.9%, P=0.22) mortalities but was not statistically significant. There were no gender differences in all-cause (70.7% vs 67%, P=0.58) or heart failure (19% vs 25%, P=0.32) readmissions.

Conclusion Perioperative complications were significantly more common in women referred for ICD/CRT-D. Although there has been a significant increase in ICD implantation rates, gender differences in the use of these devices still exist in New Zealand, in keeping with the demographics of ischaemic heart disease and systolic dysfunction between genders.

  • implantable cardioverter defibrillator (icd)
  • heart failure
  • sudden cardiac death

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Footnotes

  • Contributors KLL was involved in conception and design of the study. KLL, LC, LD and DS were involved in data collection. KLL and KS were involved in analysis and interpretation of data. KLL, KS, LC, AG and NL contributed to the writing of the manuscript as well as jointly developing the structure and arguments for the paper. All authors reviewed and approved the final manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethics approval for the study was obtained from the Central Health and Disability Ethics Committee (ethics ref: 15/CEN/58/AM02).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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