Cardiac resynchronization therapy in women versus men: observational comparative effectiveness study from the National Cardiovascular Data Registry

Robbert Zusterzeel, Erica S. Spatz, Jeptha P. Curtis, William E. Sanders, Kimberly A. Selzman, Ileana L. Pina, Haikun Bao, Angelo Ponirakis, Paul D. Varosy, Frederick A. Masoudi, Daniel A. Caños, David G. Strauss

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

BACKGROUND: Women have been under-represented in trials of cardiac resynchronization therapy-defibrillators (CRT-D). Previous studies suggest that women benefit from CRT-D at shorter QRS duration than men and that there may be no benefit of CRT-D in patients without left bundle branch block (LBBB) regardless of patient sex.

METHODS AND RESULTS: We compared sex-specific death risk in 75 079 patients with New York Heart Association class III or IV heart failure, reduced left ventricular ejection fraction, and prolonged QRS duration (≥120 ms) receiving either CRT-D or implantable cardioverter defibrillator in subgroups according to QRS morphology and 10-ms increments in QRS duration. We applied propensity score weighting to control for differences between treatments. Among patients with LBBB, women receiving CRT-D had a lower relative death risk than those receiving an implantable cardioverter-defibrillator (absolute difference, 11%; hazard ratio=0.74 [95% confidence interval, 0.68-0.81]). In men, the lower mortality with CRT-D versus implantable cardioverter defibrillator was less pronounced (absolute difference, 9%; hazard ratio=0.84 [0.79-0.89]; sex×device interaction P=0.025). In those without LBBB, the mortality difference was modest and did not differ between women and men (absolute difference, 3%; hazard ratio=0.88 [0.79-0.97] in women and absolute difference, 2%; hazard ratio=0.95 [0.91-0.998] in men; interaction P=0.17). In subgroups according to QRS duration, CRT-D was associated with better survival in both sexes with LBBB and QRS ≥130 ms, whereas there was no clear relation between QRS duration and survival in patients without LBBB regardless of patient sex.

CONCLUSIONS: In a large real-world population CRT-D was associated with a lower mortality risk in both sexes with LBBB, although more pronounced among women. Only among those with LBBB, both sexes had better survival with longer QRS duration. The mortality differences in patients without LBBB were attenuated in both sexes.

Original languageEnglish (US)
Pages (from-to)S4-S11
JournalCirculation: Cardiovascular Quality and Outcomes
Volume8
Issue number2
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

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Cardiac Resynchronization Therapy
Defibrillators
Bundle-Branch Block
Registries
Implantable Defibrillators
Mortality
Survival
Propensity Score
Stroke Volume
Heart Failure
Confidence Intervals

Keywords

  • bundle-branch block
  • cardiac resynchronization therapy
  • sex

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Cardiac resynchronization therapy in women versus men : observational comparative effectiveness study from the National Cardiovascular Data Registry. / Zusterzeel, Robbert; Spatz, Erica S.; Curtis, Jeptha P.; Sanders, William E.; Selzman, Kimberly A.; Pina, Ileana L.; Bao, Haikun; Ponirakis, Angelo; Varosy, Paul D.; Masoudi, Frederick A.; Caños, Daniel A.; Strauss, David G.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 8, No. 2, 01.03.2015, p. S4-S11.

Research output: Contribution to journalArticle

Zusterzeel, R, Spatz, ES, Curtis, JP, Sanders, WE, Selzman, KA, Pina, IL, Bao, H, Ponirakis, A, Varosy, PD, Masoudi, FA, Caños, DA & Strauss, DG 2015, 'Cardiac resynchronization therapy in women versus men: observational comparative effectiveness study from the National Cardiovascular Data Registry', Circulation: Cardiovascular Quality and Outcomes, vol. 8, no. 2, pp. S4-S11. https://doi.org/10.1161/CIRCOUTCOMES.114.001548
Zusterzeel, Robbert ; Spatz, Erica S. ; Curtis, Jeptha P. ; Sanders, William E. ; Selzman, Kimberly A. ; Pina, Ileana L. ; Bao, Haikun ; Ponirakis, Angelo ; Varosy, Paul D. ; Masoudi, Frederick A. ; Caños, Daniel A. ; Strauss, David G. / Cardiac resynchronization therapy in women versus men : observational comparative effectiveness study from the National Cardiovascular Data Registry. In: Circulation: Cardiovascular Quality and Outcomes. 2015 ; Vol. 8, No. 2. pp. S4-S11.
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abstract = "BACKGROUND: Women have been under-represented in trials of cardiac resynchronization therapy-defibrillators (CRT-D). Previous studies suggest that women benefit from CRT-D at shorter QRS duration than men and that there may be no benefit of CRT-D in patients without left bundle branch block (LBBB) regardless of patient sex.METHODS AND RESULTS: We compared sex-specific death risk in 75 079 patients with New York Heart Association class III or IV heart failure, reduced left ventricular ejection fraction, and prolonged QRS duration (≥120 ms) receiving either CRT-D or implantable cardioverter defibrillator in subgroups according to QRS morphology and 10-ms increments in QRS duration. We applied propensity score weighting to control for differences between treatments. Among patients with LBBB, women receiving CRT-D had a lower relative death risk than those receiving an implantable cardioverter-defibrillator (absolute difference, 11{\%}; hazard ratio=0.74 [95{\%} confidence interval, 0.68-0.81]). In men, the lower mortality with CRT-D versus implantable cardioverter defibrillator was less pronounced (absolute difference, 9{\%}; hazard ratio=0.84 [0.79-0.89]; sex×device interaction P=0.025). In those without LBBB, the mortality difference was modest and did not differ between women and men (absolute difference, 3{\%}; hazard ratio=0.88 [0.79-0.97] in women and absolute difference, 2{\%}; hazard ratio=0.95 [0.91-0.998] in men; interaction P=0.17). In subgroups according to QRS duration, CRT-D was associated with better survival in both sexes with LBBB and QRS ≥130 ms, whereas there was no clear relation between QRS duration and survival in patients without LBBB regardless of patient sex.CONCLUSIONS: In a large real-world population CRT-D was associated with a lower mortality risk in both sexes with LBBB, although more pronounced among women. Only among those with LBBB, both sexes had better survival with longer QRS duration. The mortality differences in patients without LBBB were attenuated in both sexes.",
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author = "Robbert Zusterzeel and Spatz, {Erica S.} and Curtis, {Jeptha P.} and Sanders, {William E.} and Selzman, {Kimberly A.} and Pina, {Ileana L.} and Haikun Bao and Angelo Ponirakis and Varosy, {Paul D.} and Masoudi, {Frederick A.} and Ca{\~n}os, {Daniel A.} and Strauss, {David G.}",
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T2 - observational comparative effectiveness study from the National Cardiovascular Data Registry

AU - Zusterzeel, Robbert

AU - Spatz, Erica S.

AU - Curtis, Jeptha P.

AU - Sanders, William E.

AU - Selzman, Kimberly A.

AU - Pina, Ileana L.

AU - Bao, Haikun

AU - Ponirakis, Angelo

AU - Varosy, Paul D.

AU - Masoudi, Frederick A.

AU - Caños, Daniel A.

AU - Strauss, David G.

PY - 2015/3/1

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N2 - BACKGROUND: Women have been under-represented in trials of cardiac resynchronization therapy-defibrillators (CRT-D). Previous studies suggest that women benefit from CRT-D at shorter QRS duration than men and that there may be no benefit of CRT-D in patients without left bundle branch block (LBBB) regardless of patient sex.METHODS AND RESULTS: We compared sex-specific death risk in 75 079 patients with New York Heart Association class III or IV heart failure, reduced left ventricular ejection fraction, and prolonged QRS duration (≥120 ms) receiving either CRT-D or implantable cardioverter defibrillator in subgroups according to QRS morphology and 10-ms increments in QRS duration. We applied propensity score weighting to control for differences between treatments. Among patients with LBBB, women receiving CRT-D had a lower relative death risk than those receiving an implantable cardioverter-defibrillator (absolute difference, 11%; hazard ratio=0.74 [95% confidence interval, 0.68-0.81]). In men, the lower mortality with CRT-D versus implantable cardioverter defibrillator was less pronounced (absolute difference, 9%; hazard ratio=0.84 [0.79-0.89]; sex×device interaction P=0.025). In those without LBBB, the mortality difference was modest and did not differ between women and men (absolute difference, 3%; hazard ratio=0.88 [0.79-0.97] in women and absolute difference, 2%; hazard ratio=0.95 [0.91-0.998] in men; interaction P=0.17). In subgroups according to QRS duration, CRT-D was associated with better survival in both sexes with LBBB and QRS ≥130 ms, whereas there was no clear relation between QRS duration and survival in patients without LBBB regardless of patient sex.CONCLUSIONS: In a large real-world population CRT-D was associated with a lower mortality risk in both sexes with LBBB, although more pronounced among women. Only among those with LBBB, both sexes had better survival with longer QRS duration. The mortality differences in patients without LBBB were attenuated in both sexes.

AB - BACKGROUND: Women have been under-represented in trials of cardiac resynchronization therapy-defibrillators (CRT-D). Previous studies suggest that women benefit from CRT-D at shorter QRS duration than men and that there may be no benefit of CRT-D in patients without left bundle branch block (LBBB) regardless of patient sex.METHODS AND RESULTS: We compared sex-specific death risk in 75 079 patients with New York Heart Association class III or IV heart failure, reduced left ventricular ejection fraction, and prolonged QRS duration (≥120 ms) receiving either CRT-D or implantable cardioverter defibrillator in subgroups according to QRS morphology and 10-ms increments in QRS duration. We applied propensity score weighting to control for differences between treatments. Among patients with LBBB, women receiving CRT-D had a lower relative death risk than those receiving an implantable cardioverter-defibrillator (absolute difference, 11%; hazard ratio=0.74 [95% confidence interval, 0.68-0.81]). In men, the lower mortality with CRT-D versus implantable cardioverter defibrillator was less pronounced (absolute difference, 9%; hazard ratio=0.84 [0.79-0.89]; sex×device interaction P=0.025). In those without LBBB, the mortality difference was modest and did not differ between women and men (absolute difference, 3%; hazard ratio=0.88 [0.79-0.97] in women and absolute difference, 2%; hazard ratio=0.95 [0.91-0.998] in men; interaction P=0.17). In subgroups according to QRS duration, CRT-D was associated with better survival in both sexes with LBBB and QRS ≥130 ms, whereas there was no clear relation between QRS duration and survival in patients without LBBB regardless of patient sex.CONCLUSIONS: In a large real-world population CRT-D was associated with a lower mortality risk in both sexes with LBBB, although more pronounced among women. Only among those with LBBB, both sexes had better survival with longer QRS duration. The mortality differences in patients without LBBB were attenuated in both sexes.

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