title: Sex differences in implantable cardioverter-defibrillator implantation indications and outcomes: lessons from the Nationwide Israeli-ICD Registry.
abstract: OBJECTIVE
  Implantable cardioverter-defibrillators (ICDs) improve survival in certain high arrhythmic risk populations. However, there are sex differences regarding both the utilization and the benefit of these devices. Using a prospective national ICD registry, we aim to compare the indications for ICD implantation as well as outcomes in implanted women vs. men.
  
  
  RESULTS
  All subjects implanted with an ICD or cardiac resynchronization therapy with a defibrillator (CRTD) in Israel between July 2010 and February 2013 were included. A total of 3544 subjects constructed the baseline cohort, of whom 615 (17%) were women. Women had the same age (64 years) and rate of secondary prevention indication (26%) as men. However, women were more likely than men to have significant heart failure symptoms (52 vs. 45%), QRS > 120 ms (41 vs. 36%), and a higher rate of non-ischaemic cardiomyopathy (54 vs. 21%, all P values <0.05). Using multivariate analysis, women were more likely to undergo CRTD implantation (odds ratio = 1.8, P < 0.01). Follow-up data were available for 1518 subjects with a mean follow-up of 12 months. During follow-up, there were no significant differences among genders in the rate of any single or the combined outcomes of appropriate device therapies, heart failure admissions, or death. First-year re-intervention rate was double among women (5.6 vs. 3.0%, P < 0.01).
  
  
  CONCLUSIONS
  In real-world setting, women implanted with an ICD differ significantly from men in their baseline characteristics and in the use of CRTD devices. These, however, did not translate into outcome differences.
authors.affiliation: Cardiology Department, Soroka Medical Center, Beer-Sheva, Israel Division of Cardiology, Department of Medicine McMaster University, Hamilton General Hospital 237 Barton Street East, Hamilton, ON L8L 2X2, Canada gamitmd@gmail.com.
authors.forename: Guy
authors.initials: G
authors.lastname: Amit
authors.affiliation: Cardiology Department, Rambam Medical Center, Haifa, Israel.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Suleiman
authors.affiliation: Cardiology Department, Soroka Medical Center, Beer-Sheva, Israel.
authors.forename: Yuval
authors.initials: Y
authors.lastname: Konstantino
authors.affiliation: Cardiology Department, Soroka Medical Center, Beer-Sheva, Israel Cardiology Department, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Luria
authors.affiliation: Cardiology Department, Hillel Yafe Hospital, Hadera, Israel.
authors.forename: Mark
authors.initials: M
authors.lastname: Kazatsker
authors.affiliation: Cardiology Department, Meir Hospital, Kfar Saba, Israel.
authors.forename: Israel
authors.initials: I
authors.lastname: Chetboun
authors.affiliation: Cardiology Department, Meir Hospital, Kfar Saba, Israel.
authors.forename: Moti
authors.initials: M
authors.lastname: Haim
authors.affiliation: IACT-Neufeld Cardiac Research Institute, Tel Hashomer, Israel.
authors.forename: Natalie
authors.initials: N
authors.lastname: Gavrielov-Yusim
authors.affiliation: IACT-Neufeld Cardiac Research Institute, Tel Hashomer, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Cardiology Department, Soroka Medical Center, Beer-Sheva, Israel Cardiology Department, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Glikson
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality; D058409:Cardiac Resynchronization Therapy Devices; D016009:Chi-Square Distribution; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D007557:Israel; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011322:Primary Prevention / Q000295:instrumentation*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D019233:Retreatment; D012307:Risk Factors; D055502:Secondary Prevention / Q000295:instrumentation*; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardiac resynchronization therapy; Implantable cardioverter-defibrillators; Outcomes; Registry; Women