Sex Differences in Advanced Heart Failure Therapies
1Heart and Vascular Institute at the Cleveland Clinic, OH. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, OH.
Circulation
|February 20, 2019
Summary
Sex differences exist in advanced heart failure therapies like defibrillators and pacemakers. Understanding these disparities is crucial for optimizing treatment and improving outcomes for both women and men with heart failure.
Area of Science:
- Cardiology
- Medical Devices
- Transplantation
Background:
- Advanced heart failure (AHF) management involves complex therapies.
- Sex-based disparities in cardiovascular disease prevalence and outcomes are increasingly recognized.
Purpose of the Study:
- To review and synthesize current literature on sex differences in AHF therapies.
- To highlight disparities in utilization, efficacy, adverse events, and controversies.
Main Methods:
- Comprehensive literature review of studies on implantable cardioverter defibrillators (ICDs), biventricular pacemakers (BVP), mechanical circulatory support (MCS), and heart transplantation (HTx).
- Focused analysis on sex-specific data regarding device implantation, clinical effectiveness, and patient outcomes.
Main Results:
- Controversies exist regarding ICD efficacy in women, yet implantation is recommended.
- Sex differences observed in BVP response, heart failure hospitalizations, and mortality.
- Disparities noted in HTx waitlist survival and MCS device utilization, with women less likely to receive LVADs.
- Similar survival with LVADs but differing adverse event profiles between sexes.
- Concerns about outcomes with female donor hearts in male recipients may relate to size, not sex.
Conclusions:
- Significant sex differences impact the effectiveness and utilization of advanced heart failure therapies.
- Further research is essential to elucidate mechanisms and tailor treatments for improved outcomes in both sexes.
- Optimizing AHF therapy requires addressing sex-specific considerations in device selection and management.
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