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Gender-specific outcomes of cardiac resynchronisation therapy with or without defibrillator

Cardiac resynchronisation therapy has been shown to significantly reduce heart failure (HF) symptoms, prevent HF hospitalisations and improve survival in HF patients with severely reduced left ventricular ejection fraction (LVEF) and a wide QRS.1 Sudden cardiac death (SCD) is also prevalent in HF patients with severely reduced LVEF, and therefore, combined protection from HF and SCD is generally warranted in this cohort. It is however not well known whether adding a defibrillator function to cardiac resynchronisation therapy provides incremental benefit, especially in the context of gender.

In their Heart publication Barra et al .2 reported retrospective analyses of outcomes of 5307 consecutive patients with ischaemic or non-ischaemic cardiomyopathy and no history of sustained ventricular tachyarrhythmia implanted either with cardiac resynchronisation therapy with defibrillator (CRT-D) or without a defibrillator (CRT-P). The primary focus of their report was to assess incremental survival benefit of CRT-D versus CRT-P by gender. Using propensity score matching, they showed no survival advantage of CRT-D versus CRT-P in men or women. Using inverse probability weighting analysis, a benefit of CRT-D over CRT-P was present in men (HR=0.78, 95% CI 0.65 to 0.94, p=0.012) but not in men (HR=0.87, 95% CI …