ICD therapy in women: Are men from Mars and women from Venus?

Abstract

Heart failure affects approximately 5.8 million people in the United States, with women composing nearly half that population. 1 Lloyd-Jones D. Adams R.J. Brown T.M. et al. Heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation. 2010; 121: e46-e215 Crossref PubMed Scopus (1385) Google Scholar The annual incidence of heart failure is approximately 670,000 in patients ages 45 years and older, with men and women affected in equal numbers. 1 Lloyd-Jones D. Adams R.J. Brown T.M. et al. Heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation. 2010; 121: e46-e215 Crossref PubMed Scopus (1385) Google Scholar Treatment of heart failure patients with severe systolic dysfunction includes optimization of medical therapy in addition to primary prevention of sudden cardiac death (SCD) with implantation of an implantable cardioverter-defibrillator (ICD). 2 Hunt S.A. Abraham W.T. Chin M.H. et al. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009; 119: e391-e479 Crossref PubMed Scopus (1400) Google Scholar , 3 Hunt S.A. Abraham W.T. Chin M.H. et al. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005; 112: e154-e235 Crossref PubMed Google Scholar This approach to the primary prevention of SCD in patients with heart failure is the result of multiple clinical trials that have evaluated the efficacy of ICDs in this population. 4 Moss A.J. Zareba W. Hall W.J. et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002; 346: 877-883 Crossref PubMed Scopus (5576) Google Scholar , 5 Bardy G.H. Lee K.L. Mark D.B. et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005; 352: 225-237 Crossref PubMed Scopus (5257) Google Scholar The integration of these results into practice guidelines has led to a significant increase in the rate of ICD implantation in the United States. 6 Hammill S.C. Kremers M.S. Kadish A.H. et al. Review of the ICD Registry's third year, expansion to include lead data and pediatric ICD procedures, and role for measuring performance. Heart Rhythm. 2009; 6: 1397-1401 Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar Gender differences in clinical outcome and primary prevention defibrillator benefit in patients with severe left ventricular dysfunction: A systematic review and meta-analysisHeart RhythmVol. 7Issue 7PreviewWomen are underrepresented in primary prevention implantable cardioverter-defibrillator (ICD) trials, and data on the benefit of ICD therapy in this subgroup are controversial. Full-Text PDF