Sex-specific mortality differences in heart failure patients with ischemia receiving cardiac resynchronization therapy

Abstract

BackgroundRecent studies have reported prognosis differences between male and female heart failure patients following cardiac resynchronization therapy (CRT). However, the potential clinical factors that underpin these differences remain to be elucidated.MethodsA meta-analysis was performed to investigate the factors that characterize sex-specific differences following CRT. This analysis involved searching the Medline (Pubmed source) and Embase databases in the period from January 1980 to September 2016.ResultsFifty-eight studies involving 33445 patients (23.08% of whom were women) were analyzed as part of this study. Only patients receiving CRT with follow-up greater than six months were included in our analysis. Compared with males, females exhibited a reduction of 33% (hazard ratio, 0.67; 95% confidence interval, 0.62–0.73; P < 0.0001) and 42% (hazard ratio, 0.58; 95% confidence interval, 0.46–0.74; P = 0.003) in all-cause mortality and heart failure hospitalization or heart failure, respectively. Following a stratified analysis of all-cause mortality, we observed that ischemic causes (p = 0.03) were likely to account for most of the sex-specific differences in relation to CRT.ConclusionThese data suggest that women have a reduced risk of all-cause mortality and heart failure hospitalization or heart failure following CRT. Based on the results from the stratified analysis, we observed more optimal outcomes for females with ischemic heart disease. Thus, ischemia are likely to play a role in sex-related differences associated with CRT in heart failure patients. Further studies are required to determine other indications and the potential mechanisms that might be associated with sex-specific CRT outcomes.

Role of gender, age and BMI in prognosis of heart failure

“…7 In addition, women are at risk of specific CHF causes such as peripartum heart disease (gestation diabetes and hypertension, preterm delivery) and, in the case of breast cancer, chemotherapy and radiotherapyinduced cardiomyopathy, associated with the use of anthracyclines and human epidermal growth factor receptor 2 (HER2) monoclonal inhibitors and X-ray locoregional treatment. 4,5 Moreover, in randomised clinical trials women are often underrepresented, 4 so clinicians frequently administer therapies the efficacy of which are not proved in real-life female patients, who are often older, with HFpEF, with different HF aetiology, with different pharmacokinetics, a better response to resynchronisation therapy, 8 a higher incidence of complications after implantable cardioverter defibrillator (ICD) implantation 9 and less orthotopic heart transplantation access. 10 In addition, age at menopause should be considered an important piece of information to acquire, in order to understand better the correct timing of changes in the cardiovascular system due to the progressive reduction in oestrogens 11 that are able to lead to microvessel damage and, ages later, to HFpEF.…”

“…Moreover, in randomised clinical trials women are often underrepresented, 4 so clinicians frequently administer therapies the efficacy of which are not proved in real-life female patients, who are often older, with HFpEF, with different HF aetiology, with different pharmacokinetics, a better response to resynchronisation therapy, 8 a higher incidence of complications after implantable cardioverter defibrillator (ICD) implantation 9 and less orthotopic heart transplantation access. 10 In addition, age at menopause should be considered an important piece of information to acquire, in order to understand better the correct timing of changes in the cardiovascular system due to the progressive reduction in oestrogens 11 that are able to lead to microvessel damage and, ages later, to HFpEF.…”

The CHA₂DS₂-VASc Score and Its Association with Long-Term Outcome in a Cardiac Resynchronization Therapy Population

“…Our study may have been underpowered in this regard since the percentage of women in the cohort was only 16% ( n = 128). Several previous studies have reported a better treatment response after CRT implantation for women [18, 19]. Female sex was, however, significantly associated with the composite end point of time to death or hospitalization for heart failure, with a lower risk than male sex.…”

“…One such tool is the CHA 2 DS 2 -VASc score, a tool developed for finding risk factors for thromboembolic events in patients with atrial fibrillation (AF) [12]. The CHA 2 DS 2 -VASc score consists of common clinical variables that are known for most patients and also happens to overlap some of the known risk factors after CRT implantation [13]. The score is commonly used by clinicians across many specialties, and especially among electrophysiologists who also often manage CRT patients.…”

Medico-Demographic Portrait of a Patient With Ischemic Heart Disease and Surgical Intervention Profiled as Cardiovascular Surgery

“…Соответственно, при всем многообразии и постоянном совершенствовании видов и методов хирургического лечения пациентов с БСК, и в частности больных ИБС, востребованность этого вида медицинской помощи не имеет ниспадающей динамики, а смертность от этой патологии продолжает удерживать лидирующую позицию среди прочих причин смертности от БСК. В ряде исследований [7][8][9] была показана взаимосвязь клинического течения, исходов медицинских вмешательств и медико-демографических характеристик пациентов кардиологического профиля, что определило актуальность оценки портрета пациента с ИБС, получившего ВМП, поскольку эти данные могут послужить основой для проведения клинико-экономического анализа применяемых медицинских технологий и разработки мероприятий по совершенствованию медицинской и лекарственной помощи.…”