Response by Hess et al to Letter Regarding Article, “Sex and Race/Ethnicity Differences in Implantable Cardioverter-Defibrillator Counseling and Use Among Patients Hospitalized With Heart Failure: Findings From the Get With The Guidelines-Heart Failure Program”
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We appreciate Drs Dhruva and Redberg’s thoughtful letter regarding our finding that counseled women were as likely as men to proceed with primary prevention implantable cardioverter-defibrillator (ICD) placement (adjusted odds ratio, 1.13; 95% confidence interval, 0.99–1.29).1
Women were indeed underrepresented in the landmark clinical trials establishing the efficacy of primary prevention ICDs. Post hoc meta-analyses of the randomized data as well as observational studies have reached divergent conclusions regarding the survival benefit of primary prevention ICDs among women compared with men, yet no significant heterogeneity in ICD benefit by sex has been demonstrated to date.2,3 Definitive randomized data likely are not forthcoming given the ethical and cost considerations surrounding a primary prevention ICD trial among women. In this setting, professional societies and especially guideline writing committees have deliberated the body of evidence and determined …