title: Primary prevention implantable cardioverter-defibrillators and survival in older women.
abstract: OBJECTIVE
  The purpose of this study was to assess the benefit of primary prevention implantable cardioverter defibrillators (ICDs) in women.
  
  
  BACKGROUND
  Clinical trials of primary prevention ICDs enrolled a limited number of women.
  
  
  METHODS
  Using a propensity score method, we matched 490 women ≥65 years of age who received an ICD during a hospitalization for heart failure in the National Cardiovascular Data Registry ICD Registry from January 1, 2006, through December 31, 2007, to 490 ICD-eligible women without an ICD hospitalized for heart failure in the Get With The Guidelines for Heart Failure database from January 1, 2006, through December 31, 2009. The primary endpoint was all-cause mortality obtained from the Medicare Claims Database. An identical analysis was conducted in men.
  
  
  RESULTS
  Median follow-up for patients with an ICD was 4.6 years versus 3.2 years for patients with no ICD. Compared with women with no ICD, those with an ICD were younger and less frequently white. In the matched cohorts, the survival of women with an ICD was significantly longer than that of women without an ICD (adjusted hazard ratio: 0.79, 95% confidence interval: 0.66 to 0.95; p = 0.013). Similarly, men with an ICD had longer survival than men without an ICD (adjusted hazard ratio: 0.73, 95% confidence interval: 0.65 to 0.83; p < 0.0001). There was no interaction between sex and the presence of an ICD with respect to survival (p = 0.44).
  
  
  CONCLUSIONS
  Among older women with left ventricular dysfunction, a primary prevention ICD was associated with a significant survival benefit that was nearly identical to that seen in men. These findings support the use of primary prevention ICDs in eligible patients regardless of sex.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, North Carolina.
authors.forename: Emily P
authors.initials: EP
authors.lastname: Zeitler
authors.affiliation: Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, North Carolina.
authors.forename: Anne S
authors.initials: AS
authors.lastname: Hellkamp
authors.affiliation: Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hammill
authors.affiliation: Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, North Carolina.
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, North Carolina.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, North Carolina.
authors.forename: Hussein R
authors.initials: HR
authors.lastname: Al-Khalidi
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.affiliation: VA Palo Alto Health Care System, Palo Alto, California.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.affiliation: Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, North Carolina.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, North Carolina.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, North Carolina.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Mark
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Hammill
authors.affiliation: Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, North Carolina.
authors.forename: Gillian D
authors.initials: GD
authors.lastname: Sanders
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Duke University Medical Center, Department of Medicine, Division of Cardiology, Durham, North Carolina. Electronic address: alkha001@mc.duke.edu.
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D011322:Primary Prevention; D057216:Propensity Score; D012042:Registries; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000401:mortality* / Q000628:therapy*
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists
keywords: heart failure; implantable cardioverter-defibrillator; mortality; primary prevention; women