Increasing sex differences in the use of cardiac resynchronization therapy with or without implantable cardioverter-defibrillator
Increasing sex differences in the use of cardiac resynchronization therapy with or without implantable cardioverter-defibrillator
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DOI：
10.1093/eurheartj/ehw598
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发表时间：
2017-05-01
影响因子：
39.3
通讯作者：
Lindvall, Charlotta
中科院分区：
文献类型：
--
作者：
Chatterjee, Neal A.;Borgquist, Rasmus;Lindvall, Charlotta
目的：以前的研究已经确定了在使用心脏复律治疗（CRT）和植入式心脏复律除颤器（ICD）的性别差异，虽然在妇女的利用不足的基础仍然知之甚少。本研究的目的是评估性别差异的CRT使用模式与我们没有ICD.Methods和结果在这个横断面研究中使用的国家住院患者样本数据库，我们确定了311 009例患者接受CRT植入在美国之间的2006年和2012年。比较了接受CRT植入的男性和女性的人口统计学和临床特征，特别关注左心室逆转重构（CRT反应，评分范围：0-4）和ICD疗效降低（评分范围：0-7）的临床预测因素。与男性相比，接受CRT植入术的女性患者更可能有≥ 3个CRT反应预测因子（47.3 vs. 33.2%，P < 0.001），而ICD疗效降低的预测因子不太可能有≥ 3个（27.0 vs. 37.3%，P < 0.001）。尽管如此，男性更有可能接受CRT，ICD（CRT-D）作为CRT类型（所有CRT植入物的88.6%与80.1%）。与CRT反应可能性最大的患者（评分>= 3）相比，CRT反应可能性最小的患者植入CRT-D的几率显著降低（adj比值比0.27 [0.24-0.31]，P < 0.001），女性的几率降低幅度大于男性（P，性别相互作用< 0.001）。在研究期间，男性与女性CRT-D植入率的差异增加（P，性别Delta时间趋势= 0.012）。结论在该大型当代队列中，CRT-D植入的性别差异与预测的CRT疗效呈负相关，并随时间推移而增加。未来努力缩小男性和女性CRT-D植入的差距可能有助于更好地调整器械选择，使其最有可能受益。
Aims Previous studies have identified sex disparities in the use of cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD), although the basis of underutilization in women remains poorly understood. The aim of this study was to assess sex differences in patterns of CRT use with our without ICD.Methods and results In this cross-sectional study using the National Inpatient Sample database we identified 311 009 patients undergoing CRT implantation in the United States between 2006 and 2012. Demographic and clinical characteristics were compared between men and women undergoing CRT implantation, with special attention to clinical predictors of left ventricular reverse remodelling (CRT response, score range: 0-4) and reduced ICD efficacy (score range: 0-7). When compared to men, women undergoing CRT implantation were significantly more likely to have >= 3 predictors of CRT response (47.3 vs. 33.2%, P < 0.001) and less likely to have >= 3 predictors of reduced ICD efficacy (27.0 vs. 37.3%, P < 0.001). Despite this, men were significantly more likely to undergo CRT with ICD (CRT-D) as the type of CRT (88.6 vs. 80.1% of all CRT implants). Compared to those with the greatest likelihood of CRT response (score >= 3), those with the least likelihood of CRT response had a significant decreased odds of CRT-D implant (adj odds ratio 0.27 [0.24-0.31], P < 0.001), with a greater decreased odds in women compared to men (P, for sex interaction < 0.001). The difference in the % of CRT-D implant in men vs. women increased over the study period (P, sex Delta time trend = 0.012).Conclusion In this large, contemporary cohort, sex differences in CRT-D implantation were inversely related to predicted CRT efficacy and have increased over time. Future efforts to narrow the gap in CRT-D implantation in men and women may help better align device selection with those most likely to benefit.