Sex difference in appropriate shocks but not mortality during long-term follow-up in patients with implantable cardioverter-defibrillators

2016 | journal article; research paper. A publication with affiliation to the University of Göttingen.

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​Sex difference in appropriate shocks but not mortality during long-term follow-up in patients with implantable cardioverter-defibrillators​
Seegers, J.; Conen, D.; Jung, K. ; Bergau, L. ; Dorenkamp, M.; Luethje, L.   & Sohns, C. et al.​ (2016) 
EP Europace18(8) pp. 1194​-1202​.​ DOI: https://doi.org/10.1093/europace/euv361 

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Authors
Seegers, Joachim; Conen, David; Jung, Klaus ; Bergau, Leonard ; Dorenkamp, Marc; Luethje, Lars ; Sohns, Christian; Sossalla, Samuel ; Fischer, Thomas H. ; Hasenfuß, Gerd ; Friede, Tim ; Zabel, Markus 
Abstract
Implantable cardioverter-defibrillators (ICDs) have been shown to improve survival, although a considerable number of patients never receive therapy. Implantable cardioverter-defibrillators are routinely implanted regardless of sex. There is continuing controversy whether major outcomes differ between men and women. In this retrospective single-centre study, 1151 consecutive patients (19% women) undergoing ICD implantation between 1998 and 2010 were followed for mortality and first appropriate ICD shock over 4.9 +/- 2.7 years. Sex-related differences were investigated using multivariable Cox models adjusting for potential confounders. During follow-up, 318 patients died, a rate of 5.9% per year among men and 4.6% among women (uncorrected P = 0.08); 266 patients received a first appropriate ICD shock (6.3% per year among men vs. 3.6% among women, P = 0.002). After multivariate correction, independent predictors of all-cause mortality were age (hazard ratio, HR = 1.04 per year of age, 95% confidence interval (CI) [1.03-1.06], P < 0.001), left ventricular ejection fraction (HR = 0.98 per %, 95% CI [0.97-1.00], P = 0.025), renal function (HR = 0.99 per mL/min/1.73 m(2), 95% CI [0.99-1.00], P = 0.009), use of diuretics (HR = 1.81, 95% CI [1.29-2.54], P = 0.0023), peripheral arterial disease (HR = 2.21, 95% CI [1.62-3.00], P < 0.001), and chronic obstructive pulmonary disease (HR = 1.48, 95% CI [1.13-1.94], P = 0.029), but not sex. Female sex (HR = 0.51, 95% CI [0.33-0.81], P = 0.013), older age (HR = 0.98, 95% CI [0.97-0.99], P < 0.001), and primary prophylactic ICD indication (HR = 0.69, 95% CI [0.52-0.93], P = 0.043) were independent predictors for less appropriate shocks. Women receive 50% less appropriate shocks than men having similar mortality in this large single-centre population. These data may pertain to individually improved selection of defibrillator candidates using risk factors, e.g. sex as demonstrated in this study.
Issue Date
2016
Journal
EP Europace 
ISSN
1099-5129
eISSN
1532-2092

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