Abstract 9791: Sex Disparities in Implantable Cardioverter Defibrillator (ICD) Outcomes: Findings From the Ontario ICD Database
BACKGROUND: Sex disparities may exist in decisions to implant an ICD, complications and patient outcomes, but contributing factors are not fully elucidated. We determined if men and women who were referred or implanted with an ICD differed in their device use, complications, and outcomes.
METHODS: We examined prospectively-enrolled patients referred for consideration of ICD implantation in Ontario between Feb 2007 to Jul 2010 in the Ontario ICD Database. Patients were followed for 45-day complications, and occurrence of ICD-delivered therapies (i.e., appropriate shock, appropriate therapy, and inappropriate therapy) and death within one-year follow-up. Multivariable-adjusted odds ratios (aOR) and hazard ratios (aHR) > 1.0 signified increased likelihood of implantation, complications, ICD-delivered therapies, or death in women.
RESULTS: Of 6021 patients (4733 men) referred for ICD implantation, 1155 women (89.7%) and 4294 men (90.7%) received devices, with an overall aOR of 0.87 (95%CI; 0.69-1.10, p=0.24). Women were significantly more likely than men to have a minor (aOR 1.55; 95%CI; 1.09-2.20, p=0.014), major (aOR 1.78, 95%CI; 1.24-2.58, p=0.002), or any complication (aOR 1.50, 95%CI; 1.12-2.00, p=0.006). Among 5213 persons (4108 men) contributing 3,860 person-years of follow-up, there was a lower likelihood of appropriate ICD-delivered therapies in women. Adjusted HRs were 0.69 (95%CI; 0.51-0.93, p=0.015) for appropriate shock, 0.73 (95%CI; 0.59-0.90, p=0.003) for appropriate ICD-delivered therapy, and 0.97 (95%CI; 0.64-1.55, p=0.885) for inappropriate shock (Figure). Mortality did not differ among male and female ICD recipients: aHR=1.00 (95%CI; 0.64-1.55, p=0.988).
CONCLUSIONS: ICD implantation rates were similar in men and women after referral to an electrophysiologist. Female ICD recipients exhibited higher rates of early complications and were less likely to experience appropriate shocks or antitachycardia therapy than men.
- © 2011 by American Heart Association, Inc.