Like men, women with heart failure benefit from an implanted defibrillator

by Bruce Sylvester: Women with heart failure are as likely as men to achieve survival benefit from receiving an implantable cardiac defibrillator, researchers reported on Jan. 12,2016 in Circulation: Heart Failure.

“Despite current guidelines recommending that health practitioners consider adding these devices to standard heart failure treatments in both women and men, women with heart failure have been less likely to receive defibrillators. These new data reinforce the existing gender-neutral guidelines,” said lead author Emily Zeitler, M.D., cardiology and research fellow at the Duke [University] Clinical Research Institute in Durham, North Carolina.

As background, the authors noted that individual clinical trials of implantable cardioverter defibrillators (ICDs) for primary prevention have included a limited number of women. In order to address this challenge, they gathered, pooled and analyzed data submitted to (US) Medicare from 264 hospitals included in the Get With the Guidelines-Heart Failure Registry.

They matched 430 women with heart failure who had received a primary prevention ICD to 430 women with heart failure who had not. They used standard statistical tools to adjust for baseline characteristic differences. Median follow-up was 3.4 versus 3.0 years.

They also matched 859 men who received an ICD with 859 who had not. Median follow-up was 3.9 versus 2.9 years.

In the matched cohorts, ICD presence associated with better survival among both women (hazard ratio, 0.78; 95% confidence interval, 0.66–0.92; P =0.003) and men (hazard ratio, 0.76; 95% confidence interval, 0.67–0.87 P <0.001).

The investigators found no statistically significant gender effect with respect to survival (P=0.79).

“Among patients with heart failure with reduced left ventricular ejection fraction, a primary prevention ICD was associated with a significant survival advantage among women and among men. These findings support guideline-directed use of primary prevention ICDs in eligible patients,” the authors concluded.

Zeitler added, “Currently, many eligible patients with heart failure are not referred to physicians who can implant the devices. If you have heart failure, ask your doctor whether you might benefit from an ICD in addition to your other therapy.”

The Agency for Healthcare Research and Quality funded the study.