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Primary prevention with defibrillator therapy in women: results from the Sudden Cardiac Death in Heart Failure Trial.
J Cardiovasc Electrophysiol. 2008 Jul; 19(7):720-4.JC

Abstract

INTRODUCTION

The Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) demonstrated that implantable cardioverter defibrillator (ICD) therapy reduced overall mortality in patients with class II or III heart failure and left ventricular ejection fraction (LVEF) <or= 35%, while amiodarone had no effect on survival. There are limited data regarding the influence of gender on outcome of patients receiving ICDs for primary prevention.

METHODS

We examined gender differences in response to treatment and outcome in this cohort.

RESULTS

Women comprised 23% of the SCD-HeFT cohort, with similar percentages in the amiodarone, ICD, and placebo groups. Compared with men, women were more likely to be non-Caucasian, to have class III heart failure, and nonischemic heart disease. After adjustment for baseline differences, overall mortality risk was lower in women than in men. The gender difference in overall mortality was seen in the placebo group, while no gender difference in overall mortality was seen in the ICD group. There was a significantly lower absolute risk of death in the placebo arm women, compared with the placebo arm men (annual mortality rate approximately 4% vs. 6%).

CONCLUSIONS

The impact of ICD therapy appears to differ between men and women in this trial, with a smaller ICD benefit among women. However, the test for an interaction between gender and therapy was not significant. The lower overall mortality risk in women in the placebo group and the smaller number of women enrolled may help to explain why treatment differences in women were much smaller and difficult to detect.

Authors+Show Affiliations

University of Pennsylvania Health System, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. andrea.russo@uphs.upenn.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18373605

Citation

Russo, Andrea M., et al. "Primary Prevention With Defibrillator Therapy in Women: Results From the Sudden Cardiac Death in Heart Failure Trial." Journal of Cardiovascular Electrophysiology, vol. 19, no. 7, 2008, pp. 720-4.
Russo AM, Poole JE, Mark DB, et al. Primary prevention with defibrillator therapy in women: results from the Sudden Cardiac Death in Heart Failure Trial. J Cardiovasc Electrophysiol. 2008;19(7):720-4.
Russo, A. M., Poole, J. E., Mark, D. B., Anderson, J., Hellkamp, A. S., Lee, K. L., Johnson, G. W., Domanski, M., & Bardy, G. H. (2008). Primary prevention with defibrillator therapy in women: results from the Sudden Cardiac Death in Heart Failure Trial. Journal of Cardiovascular Electrophysiology, 19(7), 720-4. https://doi.org/10.1111/j.1540-8167.2008.01129.x
Russo AM, et al. Primary Prevention With Defibrillator Therapy in Women: Results From the Sudden Cardiac Death in Heart Failure Trial. J Cardiovasc Electrophysiol. 2008;19(7):720-4. PubMed PMID: 18373605.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary prevention with defibrillator therapy in women: results from the Sudden Cardiac Death in Heart Failure Trial. AU - Russo,Andrea M, AU - Poole,Jeanne E, AU - Mark,Daniel B, AU - Anderson,Jill, AU - Hellkamp,Anne S, AU - Lee,Kerry L, AU - Johnson,George W, AU - Domanski,Michael, AU - Bardy,Gust H, Y1 - 2008/03/26/ PY - 2008/4/1/pubmed PY - 2009/1/10/medline PY - 2008/4/1/entrez SP - 720 EP - 4 JF - Journal of cardiovascular electrophysiology JO - J Cardiovasc Electrophysiol VL - 19 IS - 7 N2 - INTRODUCTION: The Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) demonstrated that implantable cardioverter defibrillator (ICD) therapy reduced overall mortality in patients with class II or III heart failure and left ventricular ejection fraction (LVEF) <or= 35%, while amiodarone had no effect on survival. There are limited data regarding the influence of gender on outcome of patients receiving ICDs for primary prevention. METHODS: We examined gender differences in response to treatment and outcome in this cohort. RESULTS: Women comprised 23% of the SCD-HeFT cohort, with similar percentages in the amiodarone, ICD, and placebo groups. Compared with men, women were more likely to be non-Caucasian, to have class III heart failure, and nonischemic heart disease. After adjustment for baseline differences, overall mortality risk was lower in women than in men. The gender difference in overall mortality was seen in the placebo group, while no gender difference in overall mortality was seen in the ICD group. There was a significantly lower absolute risk of death in the placebo arm women, compared with the placebo arm men (annual mortality rate approximately 4% vs. 6%). CONCLUSIONS: The impact of ICD therapy appears to differ between men and women in this trial, with a smaller ICD benefit among women. However, the test for an interaction between gender and therapy was not significant. The lower overall mortality risk in women in the placebo group and the smaller number of women enrolled may help to explain why treatment differences in women were much smaller and difficult to detect. SN - 1540-8167 UR - https://www.unboundmedicine.com/medline/citation/18373605/Primary_prevention_with_defibrillator_therapy_in_women:_results_from_the_Sudden_Cardiac_Death_in_Heart_Failure_Trial_ L2 - https://doi.org/10.1111/j.1540-8167.2008.01129.x DB - PRIME DP - Unbound Medicine ER -