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75/Sex-specific differences in survival and heart failure hospitalisation after cardiac resynchronisation therapy with or without defibrillation

European Journal of Arrhythmia & Electrophysiology. 2019;5(Suppl. 1):abstr75

Background: Women are underrepresented in cardiac resynchronisation therapy (CRT) trials. Some studies suggest that women fare better than men after CRT.

Objectives: To explore clinical outcomes in women and men undergoing CRT-defibrillation (CRT-D) or -pacing (CRT-P) in real-world clinical practice.

Methods: 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 yrs, interquartile range, 1–4 yrs).

Results: In analysis of the total population, the primary endpoint of total mortality (adjusted hazard ratio [aHR]: 0.73, 95% confidence interval [CI] 0.69–0.76) and the secondary endpoint of total mortality or HF hospitalisation (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 HF hospitalisation (aHR: 0.79, 95% CI 0.75–0.82) were lower for CRT-D than for CRT-P. 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-D in women (aHR: 0.83, p=0.013) and men (aHR: 0.69, p<0.001).

 

Conclusions: Compared to men, women lived longer and were less likely to be hospitalised for HF after CRT. In both sexes, CRT-D was superior to CRT-P with respect to survival and HF hospitalisation. The longest survival after CRT was observed in women without a history of MI.

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