Gender matters. Impact of gender on the utilization of defibrillators with cardiac resynchronisation therapy and outcome: results from the German DEVICE registry
Authors: Popescu S S , Gasperetti A , Brachmann J , Eckardt L , Kuck K H , Willems S , Lugenbiel P , Akin I , Meyer C , Schneider S , Hochadel M , Senges J , Tilz R R 
Published: May 2024

Abstract

Background
Defibrillators with cardiac resynchronisation therapy (CRT-Ds) are widely used in patients with left ventricular (LV) systolic dysfunction and high-grade intraventricular conduction delays. Real world data regarding the impact of gender on CRT-D implantation and outcome are scarce.

Purpose
To determine the impact of gender on the CRT-D devices implantation and outcome.

Methods
The German DEVICE registry is a prospective, nationwide database of ICD and CRT devices implantations and revisions. A total of 1536 patients undergoing CRT-D implantations and revisions were included between March 2007 and February 2014 in 44 centres and monitored for a median of 17.2 months. Herein we conducted the gender-based analysis of the CRT-D recipients.

Results
Only a minority of the patients in this registry was females (329; 21,4%). The demographic data (age and BMI) were similar between genders. The female population was less likely to have a coronary artery disease (35.3% vs. 56.7%; p&lt;0.001), but more likely to have dilated cardiomyopathy (61.1% vs. 49.5%; p&lt;0.001). Significantly less women had a LVEF ≤ 35% (90.6% vs. 94.8%, p=0.005).
A total of 84.2% of females and 80.2% of males received a device for the primary prevention of sudden cardiac death (SCD; p=0.10). Women were more likely to have a history of ventricular fibrillation (44.2% vs. 23.0%, p=0.002) and resuscitation (p=0.01), but less likely to have a history of ventricular tachycardia (44.2% vs. 61.9%; p=0.019). Significantly more women than men showed a left bundle branch block at implantation (89.7% vs. 80.9%, p&lt;0.001). A QRS duration of at ≥ 150 ms was noted in 74.8% of women and 71.5% of men (p=0.25), while significantly more women had a QRS of ≥ 120 ms (97.0% vs. 94.2%; p=0.043). The overall incidence of major periprocedural complications and in hospital complications was similar between groups (3.6% vs 2.4%, p=0.25 and 6.0% vs. 5.8%, p=0.88 respectively), however a pneumothorax requiring intervention was more common among women (1.8% vs. 0.5%, p=0.027). The rate of device revision until discharge and the in-hospital mortality did not differ between genders. The Kaplan-Meier estimated 1-year all-cause mortality was 6.3% for women and 8.2% for men (p=0.25, Fig.1), while the estimated incidence of death or defibrillator shocks was 11.0% and 15.1%, respectively (p=0.051). The non-lethal complications and device revisions during follow-up (FU) were similar between genders. Women showed a lower non-device-dependent cardiovascular hospitalisation rate (8.2% vs. 13.1%; p=0.043) and had more fear of receiving a device shock than men (p=0.002).

Conclusions
In this real-life CRT-D patient cohort only a minority of patients were females. Women had a higher rate of pneumothorax requiring intervention. The 1-year mortality and the complications during FU were similar between genders. Women had a lower rate of non-device-dependent cardiovascular hospitalisation during FU.Fig.1. Kaplan-Meier estimated survival.