Survival in women versus men following implantation of pacemakers,defibrillators,and cardiac resynchronization therapy devices in a large,nationwide cohort

Background-whether outcomes differ between sexes following treatment with pacemakers (pm),implantable cardioverter defibrillators,and cardiac resynchronization therapy (crt) devices is unclear. methods and results-consecutive us patients with newly implanted pm,implantable cardioverter defibrillators,and crt devices from a large remote monitoring database between 2008 and 2011 were included in this observational cohort study. sex-specific all-cause survival postimplant was compared within each device type using a multivariable cox proportional hazards model,stratified on age and adjusted for remote monitoring utilization and zip-based socioeconomic variables. a total of 269 471 patients were assessed over a median 2.9 [interquartile range,2.2,3.6] years. unadjusted mortality rates (mr; deaths/100 000 patientyears) were similar between women versus men receiving pms (n = 115 076,55% male; mr 4193 versus mr 4256,respectively; adjusted hazard ratio,0.87; 95% ci,0.84-0.90; p < 0.001) and implantable cardioverter defibrillators (n = 85 014,74% male; mr 4417 versus mr 4479,respectively; adjusted hazard ratio,0.98; 95% ci,0.93-1.02; p = 0.244). in contrast,survival was superior in women receiving crt defibrillators (n = 61 475,72% male; mr 5270 versus male mr 7175; adjusted hazard ratio,0.73; 95% ci,0.70-0.76; p < 0.001) and also crt pacemakers (n = 7906,57% male; mr 5383 versus male mr 7625,adjusted hazard ratio,0.69; 95% ci,0.61-0.78; p < 0.001). this relative difference increased with time. these results were unaffected by age or remote monitoring utilization. conclusions-women accounted for less than 30% of high-voltage implants and fewer than half of low-voltage implants in a large,nation-wide cohort. survival for women and men receiving implantable cardioverter defibrillators and pms was similar,but dramatically greater for women receiving both defibrillator- and pm-based crt. © 2017 the authors.