title: Toward Sex-Specific Guidelines for Cardiac Resynchronization Therapy?
abstract: An important treatment for patients with heart failure is cardiac resynchronization therapy (CRT). Even though only 20% of women were included in clinical trials for CRT, a benefit has been shown in recent studies for subgroups of women compared to their male counterparts. Given this low inclusion rate of women in clinical studies, professional society guideline-based CRT recommendations, such as those by the American College of Cardiology Foundation (ACCF)/American Heart Association (AHA)/Heart Rhythm Society (HRS), may not truly represent the best treatment for women, especially since most of the reports that showed this greater benefit in women were published after the latest guidelines. Despite having research and multiple publications regarding sex-specific heart failure outcomes and response to CRT, the ACCF/AHA/HRS guidelines have not yet been updated to account for the recent information regarding the differences in benefit for women and men with similar patient characteristics. This review discusses the physiology behind CRT, sex-specific characteristics of heart failure, and cardiac electrophysiology and summarizes the current sex-specific literature to encourage consideration of CRT guidelines for women and men separately.
authors.affiliation: Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA. robbert.zusterzeel@fda.hhs.gov.|Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands. robbert.zusterzeel@fda.hhs.gov.|Harvard T.H. Chan School of Public Health, Boston, MA, USA. robbert.zusterzeel@fda.hhs.gov.
authors.forename: Robbert
authors.initials: R
authors.lastname: Zusterzeel
authors.affiliation: Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Selzman
authors.affiliation: Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Sanders
authors.affiliation: Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: O'Callaghan
authors.affiliation: Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Caños
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Kevin
authors.initials: K
authors.lastname: Vernooy
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Frits W
authors.initials: FW
authors.lastname: Prinzen
authors.affiliation: Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Anton P M
authors.initials: AP
authors.lastname: Gorgels
authors.affiliation: Center for Devices and Radiological Health, US Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA.
authors.forename: David G
authors.initials: DG
authors.lastname: Strauss
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000592:standards*; D058409:Cardiac Resynchronization Therapy Devices / Q000592:standards*; D004867:Equipment Design; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D012737:Sex Factors; D016896:Treatment Outcome
keywords: Cardiac resynchronization therapy; Guidelines; Outcomes; Sex; Women