Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy in Women

Inter-American Society of Cardiology (CIFACAH-ELECTROSIAC) and Latin-American Heart Rhythm Society (LAHRS): multidisciplinary review on the appropriate use of implantable cardiodefibrillator in heart failure with reduced ejection fraction

“…In any case, this comorbidity, especially when associated with others, limits the benefit that an ICD could provide. In the short-term mortality risk scale mentioned above (PACE risk score) (62), CKD defined as creatinine > 2 mg/dl is the only one of the 4 factors considered that is given a score of 2. A score > 3 multiplies by 4 the mortality compared to those with a value < 3 [66].…”

“…In any case, it seems quite clear that women included in studies generally have a higher risk due to comorbidities and are also older, which determines a higher non-arrhythmic or non-cardiac mortality, which could be influencing the results [ 62 ]. These authors also review other potential reasons for this distinction in a recent publication where epidemiological differences (the incidence of SCD is 3 times higher in men) and clinical differences stand out: 2/3 of women with SCD have coronary heart disease versus 50% of men; men present more frequently with electrically shockable rhythms while women do so with electrical activity without pulse or asystole; the diagnosis of structural heart disease is less frequent in women, they are less frequently referred to a specialist and this option is less frequently offered to them, in addition to having a greater chance of being discharged from the hospital after an episode.…”

Representation of women in heart failure clinical trials: Barriers to enrollment and strategies to close the gap

“…Furthermore, under-representation of women in clinical trials have resulted in misinterpretation of under-powered subgroup analyses in which women appeared to have differential benefit and side effect profiles from therapies such as angiotensin-converting enzyme inhibitors or implantable cardioverter defibrillators [ 11 – 15 ]. Most of these erroneous interpretations have since been corrected with meta-analyses demonstrating benefit with guideline directed medical therapy in women [ 16 ].…”

Differences in clinical characteristics and reported quality of life of men and women undergoing cardiac resynchronization therapy

“…3 Patient sex has been reported to influence response to CRT, with an overall higher response rate, especially with regard to reverse remodelling, reported in women. [4][5][6][7][8] Other patient characteristics, including QRS morphology and duration, dyssynchrony, scar burden, cardiomyopathy aetiology, age, height, New York Heart Association (NYHA) class, and prior HF hospitalization, have all also been associated with the extent of clinical benefit with CRT. [9][10][11][12] As some of these characteristics differ between the sexes, the improved CRT response in women might be secondary to the sex-related difference in patient characteristics associated with response.…”

“…However, the benefit of CRT varies with limited clinical improvement or reverse remodelling observed in approximately 30–40% of device recipients 3 . Patient sex has been reported to influence response to CRT, with an overall higher response rate, especially with regard to reverse remodelling, reported in women 4–8 . Other patient characteristics, including QRS morphology and duration, dyssynchrony, scar burden, cardiomyopathy aetiology, age, height, New York Heart Association (NYHA) class, and prior HF hospitalization, have all also been associated with the extent of clinical benefit with CRT 9–12 .…”