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Published on: February 28, 2012
Gender differences in procedure-related adverse events in patients receiving implantable cardioverter-defibrillator
Pamela N Peterson1, Stacie L Daugherty, Yongfei Wang
1Denver Health Medical Center, Denver, Colo. 80204, USA. Pamela.Peterson@uchsc.edu
Insights
Women face higher risks for adverse events during implantable cardioverter-defibrillator (ICD) procedures. This study found women had significantly more in-hospital adverse events after ICD implantation compared to men.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Research
Background:
- Women have higher risks for adverse events with invasive cardiac procedures.
- Understanding gender-based differences in implantable cardioverter-defibrillator (ICD) therapy outcomes is crucial.
Purpose of the Study:
- To compare in-hospital adverse event rates between men and women undergoing first-time ICD implantation in community practice.
Main Methods:
- Analysis of 161,470 patients from the National Cardiovascular Data Registry ICD Registry (2006-2007).
- Comparison of in-hospital adverse events, including major adverse events, between genders.
- Multivariable analysis adjusted for demographic, clinical, procedural, physician, and hospital characteristics.
Main Results:
- Women comprised 27% of patients and were more likely to have heart failure and worse functional status.
- Unadjusted analyses showed higher rates of any adverse event (4.4% vs 3.3%) and major adverse events (2.0% vs 1.1%) in women.
- Multivariable models indicated a significantly higher risk for women: any adverse event (OR 1.32) and major adverse events (OR 1.71).
Conclusions:
- Women experience higher rates of in-hospital adverse events following ICD implantation.
- Further research is needed to identify reasons for these disparities and develop risk-reduction strategies for women.
Background:
Women are at higher risk than men for adverse events with certain invasive cardiac procedures. Our objective was to compare rates of in-hospital adverse events in men and women receiving implantable cardioverter- defibrillator (ICD) therapy in community practice.
Methods And Results:
Using the National Cardiovascular Data Registry ICD Registry, we identified patients undergoing first-time ICD implantation between January 2006 and December 2007. Outcomes included in-hospital adverse events after ICD implantation. Multivariable analysis assessed the association between gender and in-hospital adverse events, with adjustment for demographic, clinical, procedural, physician, and hospital characteristics. Of 161,470 patients, 73% were male, and 27% were female. Women were more likely to have a history of heart failure (81% versus 77%, P<0.01), worse New York Heart Association functional status (57% versus 50% in class III and IV, P<0.01), and nonischemic cardiomyopathy (44% versus 27%, P<0.01) and were more likely to receive biventricular ICDs (39% versus 34%, P<0.01). In unadjusted analyses, women were more likely to experience any adverse event (4.4% versus 3.3%, P<0.001) and major adverse events (2.0% versus 1.1%, P<0.001). In multivariable models, women had a significantly higher risk of any adverse event (OR 1.32, 95% CI 1.24 to 1.39) and major adverse events (OR 1.71, 95% CI 1.57 to 1.86).
Conclusions:
Women are more likely than men to have in-hospital adverse events related to ICD implantation. Efforts are needed to understand the reasons for higher ICD implantation-related adverse event rates in women and to develop strategies to reduce the risk of these events.
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