Sex Disparities in the Choice of Cardiac Resynchronization Therapy Device: An Analysis of Trends, Predictors, and
Mohamed Osama Mohamed1, Tahmeed Contractor2, Donah Zachariah3
1Keele Cardiovascular Research Group, Centre for Prognosis Research, Institutes of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.
Insights
Women are less likely to receive cardiac resynchronization therapy defibrillators (CRT-D) compared to men and face higher complication risks. This highlights sex-based disparities in device selection and outcomes for CRT therapy.
Area of Science:
- Cardiology
- Medical Devices
- Health Disparities
Background:
- Limited evidence exists on sex-based differences in cardiac resynchronization therapy (CRT) device selection (CRT-P vs. CRT-D).
- Understanding these differences is crucial for addressing potential sex-dependent disparities in complications and treatment decisions.
Purpose of the Study:
- To investigate the influence of sex on the choice between CRT with pacemaker (CRT-P) and CRT with defibrillator (CRT-D).
- To identify sex-dependent differences in periprocedural complications associated with CRT device implantation.
Main Methods:
- Analysis of 400,823 de novo CRT implantations from the US National Inpatient Sample (2004-2014).
- Stratification by device type (CRT-P and CRT-D).
- Multivariable logistic regression models to assess the association of female sex with CRT-D receipt and complications.
Main Results:
- Women constituted 41.5% of CRT-P and 27.8% of CRT-D recipients, with increasing percentages over time.
- Women had significantly lower odds of receiving CRT-D (OR 0.66) compared to men, a trend consistent over 11 years.
- Women experienced increased odds of procedure-related complications (bleeding, thoracic, cardiac) with CRT-D but not CRT-P implantation.
Conclusions:
- Women persistently show reduced odds of receiving CRT-D compared to men.
- Factors influencing CRT device choice include comorbidities like atrial fibrillation, malignancies, renal failure, and patient demographics.
- This study underscores significant sex-based disparities in CRT device selection and associated complication risks.
Background:
There is limited evidence on the influence of sex on the decision to implant a cardiac resynchronization therapy device with pacemaker (CRT-P) or defibrillator (CRT-D) and the existence of sex-dependent differences in complications that may affect this decision.
Methods:
All patients undergoing de novo CRT implantation (2004-2014) in the United States National Inpatient Sample were included and stratified by device type (CRT-P and CRT-D). Multivariable logistic regression models were conducted to assess the association of female sex with receipt of CRT-D and periprocedural complications.
Results:
Out of 400,823 weighted CRT procedural records, the overall percentages of women undergoing CRT-P and CRT-D implantations were 41.5% and 27.8%, respectively, and these percentages increased compared with men over the study period. Women were less likely to receive CRT-D (odds ratio 0.66, 95% confidence interval 0.64-0.67), and this trend remained stable throughout the study period (P = 0.06). Furthermore, compared with men, women were associated with increased odds of procedure-related complications (bleeding, thoracic, and cardiac) in the CRT-D group but not in the CRT-P group. Factors such as atrial fibrillation, malignancies, renal failure, advanced age (> 60 years), and admission to nonurban/small hospitals favoured the receipt of CRT-P over CRT-D, whereas history of ischemic heart disease, cardiac arrest ,or ventricular arrhythmias favoured the receipt of CRT-D over CRT-P.
Conclusions:
Women were associated with persistently reduced odds of receipt of CRT-D compared with men over an 11-year period. This study identifies important factors that predict the choice of CRT device offered to patients in the United States.
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