Sex differences in the use of implantable cardioverter-defibrillators for primary and secondary prevention of sudden cardiac death
Sex differences in the use of implantable cardioverter-defibrillators for primary and secondary prevention of sudden cardiac death
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DOI：
10.1001/jama.298.13.1517
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发表时间：
2007-10-03
影响因子：
120.7
通讯作者：
Schulman, Kevin A.
中科院分区：
文献类型：
--
作者：
Curtis, Lesley H.;Al-Khatib, Sana M.;Schulman, Kevin A.
背景以前关于植入式心脏复律除颤器（ICD）使用的性别差异的研究早于最近医疗保险覆盖范围的扩大，并且没有提供多年的患者随访。和参与者分析了1991年至2005年期间从美国医疗保险和医疗补助服务中心获得的5%的研究可识别文件的全国样本。患者年龄在65岁或65岁以上，有医疗保险按服务收费的保险，诊断为急性心肌梗死和心力衰竭或心肌病，但既往无心脏骤停或室性心动过速（即，一级预防队列[n = 65 917名男性和70 504名女性]），或心脏骤停或室性心动过速（即，二级预防队列[n = 52252名男性和47411名女性]），从1999年到2005年。主要结果测量ICD治疗的接受情况和1年时的全因死亡率。32.3/1000名男性和8.6/1000名女性在进入队列的1年内接受ICD治疗。在多变量分析中，男性比女性更可能接受ICD治疗（风险比[HR]，3.15; 95%置信区间[CI]，2.86-3.47）。在入组后180天存活的男性和女性中，接受ICD治疗的患者在随后一年的死亡风险并没有显著降低（HR，1.01; 95% CI，0.82-1.23）。在2005年的二级预防队列中，每1000名男性中有102.2人接受ICD治疗，每1000名女性中有38.4人接受ICD治疗。控制人口统计学变量和共病条件，男性比女性更可能接受ICD治疗（HR，2.44; 95%CI，2.30-2.59）。在进入队列后30天存活的男性和女性中，接受ICD治疗的患者在随后一年中死亡率的风险显著降低（HR，0.65; 95%CI，0.60-0.71）。结论在医疗保险人群中，女性接受ICD治疗作为心脏性猝死的一级或二级预防的可能性显著低于男性。
Context Previous studies of sex differences in the use of implantable cardioverter-defibrillators (ICDs) predate recent expansions in Medicare coverage and did not provide patient follow-up over multiple years.Objective To examine sex differences in ICD use for primary and secondary prevention of sudden cardiac death.Design, Setting, and Participants Analysis of a 5% national sample of research-identifiable files obtained from the US Centers for Medicare & Medicaid Services for the period 1991 through 2005. Patients were those aged 65 years or older with Medicare fee-for-service coverage and diagnosed with acute myocardial infarction and either heart failure or cardiomyopathy but no prior cardiac arrest or ventricular tachycardia (ie, the primary prevention cohort [n = 65 917 men and 70 504 women]), or with cardiac arrest or ventricular tachycardia (ie, the secondary prevention cohort [n = 52 252 men and 47 411 women]), from 1999 through 2005.Main Outcome Measures Receipt of ICD therapy and all-cause mortality at 1 year.Results In the 2005 primary prevention cohort, 32.3 per 1000 men and 8.6 per 1000 women received ICD therapy within 1 year of cohort entry. In multivariate analyses, men were more likely than women to receive ICD therapy (hazard ratio [HR], 3.15; 95% confidence interval [CI], 2.86-3.47). Among men and women alive at 180 days after cohort entry, the hazard of mortality in the subsequent year was not significantly lower among those who received ICD therapy (HR, 1.01; 95% CI, 0.82-1.23). In the 2005 secondary prevention cohort, 102.2 per 1000 men and 38.4 per 1000 women received ICD therapy. Controlling for demographic variables and comorbid conditions, men were more likely than women to receive ICD therapy (HR, 2.44; 95% CI, 2.30-2.59). Among men and women alive at 30 days after cohort entry, the hazard of mortality in the subsequent year was significantly lower among those who received ICD therapy (HR, 0.65; 95% CI, 0.60-0.71).Conclusion In the Medicare population, women are significantly less likely than men to receive ICD therapy for primary or secondary prevention of sudden cardiac death.