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Trends of sex differences in outcomes of cardiac electronic device implantations in the United States

Osama Mohamed, Mohamed; Santos Volgman, Annabelle; Contractor, Tahmeed; Sharma, Parikshit S.; Shing Kwok, Chun; Rashid, Muhammad; Martin, Glen P.; Barker, Diane; Patwala, Ashish; Mamas, Mamas A.

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Authors

Mohamed Osama Mohamed

Annabelle Santos Volgman

Tahmeed Contractor

Parikshit S. Sharma

Chun Shing Kwok

Glen P. Martin

Diane Barker

Ashish Patwala



Abstract

Background The disparity in outcomes of CIED implantations between sexes has been previously demonstrated in device-specific cohorts (e.g. implantable cardioverter defibrillators (ICD)). However, it is unclear whether sex differences are present with all types of CIED and, if so, what the trends of such differences were in recent years. Methods Using the National Inpatient Sample, all hospitalizations between 2004 and 2014 for de novo implantation of permanent pacemakers (PPM), cardiac resynchronization therapy with or without a defibrillator (CRT-D and CRT-P, respectively) and ICD were analyzed to examine the association between sex and in-hospital acute complications of CIED implantation. Results Out of 2,815,613 hospitalizations for de novo CIED implantation, 41.9% were performed on women. Women were associated with increased adjusted odds of adverse procedural complications (major adverse cardiovascular complications: 1.17 [1.16, 1.19], bleeding: 1.13 [1.12, 1.15], thoracic: 1.42 [1.40, 1.44], cardiac: 1.44 [1.38, 1.50]), while the adjusted odds of in-hospital all-cause mortality compared to men was 0.96 [0.94, 1.00]. The odds of adverse complications in the overall CIED cohort were persistently raised in women throughout the study period, whereas similar odds of all-cause mortality across the sexes were observed throughout the study period. Conclusion In a national cohort of CIED implantations we demonstrate that women are at an overall higher risk of procedure-related adverse events compared to men, but no increased risk of all-cause mortality. Further studies are required to identify procedural techniques that would improve outcomes amongst women undergoing such procedures.

Acceptance Date Aug 4, 2019
Publication Date Jan 1, 2020
Publicly Available Date Mar 28, 2024
Journal Canadian Journal of Cardiology
Print ISSN 0828-282X
Publisher Elsevier
Pages 69-78
DOI https://doi.org/10.1016/j.cjca.2019.08.012
Keywords Cardiac devices; pacemakers; defibrillators; cardiac resynchronization; sex; trends; outcomes; treatment
Publisher URL http://doi.org/10.1016/j.cjca.2019.08.012

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