Women sometimes benefit more from cardiac resynchronization therapy than men

Cardiac resynchronization therapy plus defibrillator implantation (CRT-D) sometimes helps women with heart failure more than men, although women are less likely to receive CRT-D than men.

Women are underrepresented in CRT trials for , making up only about 20 percent of participants. In selected CRT, or biventricular pacing, is used to help improve the heart's rhythm. In addition to improving symptoms, CRT can decrease hospitalizations and reduce risk of death in with heart failure.

The authors combined data from three large trials of CRT-D vs. (ICD) in patients with mild heart failure (predominantly New York Heart Association Class II). The authors examined whether with left bundle branch block (LBBB) benefit from CRT-D at a shorter QRS duration (portion of the EKG tracing that corresponds to ventricular depolarization) than men with LBBB.

Women benefitted more than men and the main difference came in patients with LBBB and a QRS of 130 to 149 . In this group, women had a 76 percent reduction in heart failure (absolute difference 23%) or death and a 76 percent reduction in death alone (absolute difference 9%), but there was no significant benefit in men. Neither sex benefitted from CRT-D at QRS shorter than 130 milliseconds and both sexes benefitted at QRS of 150 milliseconds or longer. The finding is important because recent guidelines limit the class I indication for CRT-D to patients with LBBB and QRS of 150 milliseconds or longer.

"Overall, this study highlights the importance of sex-specific analysis in medical device clinical studies and the public health value of combining individual-patient data from clinical trials submitted to the FDA." Robbert Zusterzeel, M.D., and colleagues at the Center for Devices and Radiological Health at the U.S. Food and Drug Administration, Silver Spring, Md. said in their JAMA Internal Medicine article.

In a related commentary, C. Noel Bairey Merz, M.D., of the Cedars Sinai Heart Institute, Los Angeles, Calif., and Vera Regitz-Zagrosek, M.D., of Charite University Medicine, Berlin, write: "There are numerous differences in cardiovascular disease (CVD) between men and women. … There are also important sex differences in use of cardiac devices."

"These results also shed light on a major contributor to the misdiagnosis and suboptimal treatment of CVD in women: guidelines are typically based on a male standard and do not address important differences in women."

More information: JAMA Intern Med. Published online June 23, 2014. DOI: 10.1001/jamainternmed.2014.2717
JAMA Intern Med. Published online June 23, 2014. DOI: 10.1001/jamainternmed.2014.320

add to favorites email to friend print save as pdf

Related Stories

FDA approves expanded indication for CRT devices

Apr 15, 2014

(HealthDay)—The U.S. Food and Drug Administration has approved an application from Medtronic for revised labeling for two cardiac resynchronization pacemakers (CRT-P) and eight cardiac resynchronization ...

Recommended for you

Cerebrovascular reserve-based strategy is cost-effective

Jan 29, 2015

(HealthDay)—A decision rule based on assessment of cerebrovascular reserve (CVR) seems to be cost-effective for prevention of stroke in asymptomatic patients with carotid artery stenosis, according to a ...

New hypertension guidelines could save lives and money

Jan 28, 2015

Full implementation of new hypertension guidelines could prevent 56,000 cardiovascular disease events (mostly heart attacks and strokes) and 13,000 deaths each year, without increasing overall health care costs, an analysis ...

Manchester United's rising stars revolutionize heart health

Jan 28, 2015

A unique research project to identify the effects of exercise on young hearts has been announced today [Wednesday 28 January 2015]. Manchester United's Academy players are being put through their paces having their hearts ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.