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The influence of sex and age on ventricular arrhythmia in a population-based registry
Kimberly Styles1, John Sapp1, Martin Gardner1
1Department of Medicine, QE, II Health Sciences Centre, Halifax, Canada.
Insights
Men are more likely to receive appropriate implantable cardioverter-defibrillator (ICD) therapy than women. However, older women experience a similar risk of appropriate ICD therapy as men, highlighting an age and sex interaction in ventricular arrhythmia.
Area of Science:
- Cardiology
- Electrophysiology
- Public Health
Background:
- Previous studies indicate men receive more appropriate implantable cardioverter-defibrillator (ICD) therapy, despite similar mortality rates.
- Population-based data are needed to explore sex and age interactions in ICD therapy.
Purpose of the Study:
- To investigate the interplay of sex and age on ventricular arrhythmia occurrence in patients receiving an ICD.
Main Methods:
- Analysis of 776 patients from a provincial ICD registry.
- Comparison of appropriate ICD therapy rates between men and women across different age groups.
- Statistical adjustment for clinical factors including New York Heart Association class, ejection fraction, and coronary artery disease.
Main Results:
- No significant difference in overall mortality between men and women.
- Men were significantly more likely to receive appropriate ICD therapy than women.
- Younger men (<60 years) had a significantly higher hazard ratio for appropriate ICD therapy compared to younger women (HR 3.22).
- No significant sex difference in appropriate ICD therapy was observed in patients over 60 years.
- The interaction between age and sex remained significant after multivariable adjustment (p=0.02).
Conclusions:
- The risk of appropriate ICD therapy increases with age in women, converging with men's risk in older age groups.
- Further research into the mechanisms underlying the age and sex interaction in ventricular arrhythmia is warranted.
Background:
Post-hoc analyses of clinical trials and population-based studies have shown no difference in mortality between men and women, but often show that men are more likely to receive appropriate ICD therapy. We utilized a population-based registry to investigate the interaction of sex and age and the occurrence of ventricular arrhythmia in an ICD population.
Methods And Results:
A total of 776 consecutive patients receiving an ICD for primary or secondary prevention in a provincial ICD registry were studied. No significant mortality difference was found between men and women (27.5% versus 23.7%, p=0.39). Overall, men were more likely to receive appropriate ICD therapy compared to women (39.3% versus 26.7%, p=0.006). The hazard ratio for appropriate therapy in men vs. women <60years of age was 3.22, CI 95% (1.56-6.65), p=0.002, and the same comparison in men vs. women over the age of 60 showed no significant difference (HR 1.11, CI 95% [0.74-1.65], p=0.61). This interaction between age and sex remained significant when adjusted for New York Heart Associated Class, ejection fraction, coronary artery disease and indication for ICD (p=0.02).
Conclusions:
This study demonstrates that the risk of appropriate ICD therapy increases as women are older, reaching similar risk as men in that age group. Further study of the mechanism of the interaction of age and sex as they modulate the occurrence of ventricular arrhythmia may be warranted.
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