Use of implantable cardioverter defibrillators for primary prevention in the community: do women and men equally meet trial enrollment criteria?
BACKGROUND
Fewer women than men undergo implantable cardioverter defibrillator (ICD) implantation for the primary prevention of sudden cardiac death. The criteria used to select patients for ICD implantation may be more permissive among men than for women. We hypothesized that women who undergo primary prevention ICD implantation more often meet strict trial enrollment criteria for this therapy.


METHODS
We studied 59,812 patients in the National Cardiovascular Data Registry ICD registry undergoing initial primary prevention ICD placement between January 2005 and April 2007. Patients were classified as meeting or not meeting enrollment criteria of either the MADIT-II or SCD-HeFT trials. Multivariable analyses assessed the association between gender and concordance with trial criteria adjusting for demographic, clinical, and system characteristics.


RESULTS
Among the cohort, 27% (n = 16,072) were women. Overall, 85.2% of women and 84.5% of men met enrollment criteria of either trial (P = .05). In multivariable analyses, women were equally likely to meet trial criteria (OR 1.04, 95% CI 0.99-1.10) than men. Significantly more women than men met the trial enrollment criteria among patients older than age 65 (86.6% of women vs 85.3% of men, OR 1.11, 95% CI 1.03-1.19), but this difference was not found among younger patients (82.5% of women vs 83.0% of men, OR 0.97, 95% CI 0.89-1.07).


CONCLUSIONS
In a national cohort undergoing primary prevention ICD implantation, older women were only slightly more likely then men to meet the enrollment criteria for MADIT II or SCD-HeFT. Relative overutilization in men is not an important explanation for gender differences in ICD implantation.
Daugherty
Stacie L
SL
University of Colorado Denver, Division of Cardiology, 12631 E. 17th Ave., Mailstop B130, PO Box 6511, Aurora, CO 80045, USA. stacie.daugherty@ucdenver.edu
Peterson
Pamela N
PN
Wang
Yongfei
Y
Curtis
Jeptha P
JP
Heidenreich
Paul A
PA
Lindenfeld
Joann
J
Vidaillet
Humberto J
HJ
Masoudi
Frederick A
FA
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004608:Eligibility Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011322:Primary Prevention; D012042:Registries; D012737:Sex Factors; D014481:United States