title: Comparative Effectiveness of Implantable Cardioverter Defibrillators for Primary Prevention in Women.
abstract: BACKGROUND
  Clinical trials of implantable cardioverter defibrillators (ICDs) for primary prevention enrolled a limited number of women. We sought to examine clinical practice data to compare survival rates among women with heart failure with or without a primary prevention ICD.
  
  
  RESULTS
  We linked data from 264 US hospitals included in the Get With The Guidelines for Heart Failure registry with data from the Centers for Medicare and Medicaid Services. From these sources, we propensity score matched 430 women with heart failure who received a primary prevention ICD to 430 women who did not; we further adjusted using a Cox proportional hazards model. Median follow-up was 3.4 and 3.0 years. For comparison, we matched 859 men receiving an ICD with 859 who did not; median follow-up was 3.9 versus 2.9 years. In the matched cohorts, an ICD was associated with similarly better survival in women (hazard ratio, 0.78; 95% confidence interval, 0.66-0.92; P=0.003) and men (hazard ratio, 0.76; 95% confidence interval, 0.67-0.87 P<0.001). There was no interaction between sex and presence of an ICD with respect to survival (P=0.79).
  
  
  CONCLUSIONS
  Among patients with heart failure with reduced left ventricular ejection fraction, a primary prevention ICD was associated with a significant survival advantage among women and among men. These findings support guideline-directed use of primary prevention ICDs in eligible patients.
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., A.S.H., A.F.H., E.D.P., G.D.S., S.M.A.-K.); Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC (E.P.Z., A.F.H., E.D.P., S.M.A.-K.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Medicine, Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-University of California, Los Angeles Medical Center (G.C.F.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.).
authors.forename: Emily P
authors.initials: EP
authors.lastname: Zeitler
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., A.S.H., A.F.H., E.D.P., G.D.S., S.M.A.-K.); Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC (E.P.Z., A.F.H., E.D.P., S.M.A.-K.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Medicine, Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-University of California, Los Angeles Medical Center (G.C.F.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.).
authors.forename: Anne S
authors.initials: AS
authors.lastname: Hellkamp
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., A.S.H., A.F.H., E.D.P., G.D.S., S.M.A.-K.); Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC (E.P.Z., A.F.H., E.D.P., S.M.A.-K.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Medicine, Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-University of California, Los Angeles Medical Center (G.C.F.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.).
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Schulte
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., A.S.H., A.F.H., E.D.P., G.D.S., S.M.A.-K.); Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC (E.P.Z., A.F.H., E.D.P., S.M.A.-K.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Medicine, Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-University of California, Los Angeles Medical Center (G.C.F.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., A.S.H., A.F.H., E.D.P., G.D.S., S.M.A.-K.); Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC (E.P.Z., A.F.H., E.D.P., S.M.A.-K.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Medicine, Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-University of California, Los Angeles Medical Center (G.C.F.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.).
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., A.S.H., A.F.H., E.D.P., G.D.S., S.M.A.-K.); Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC (E.P.Z., A.F.H., E.D.P., S.M.A.-K.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Medicine, Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-University of California, Los Angeles Medical Center (G.C.F.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., A.S.H., A.F.H., E.D.P., G.D.S., S.M.A.-K.); Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC (E.P.Z., A.F.H., E.D.P., S.M.A.-K.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Medicine, Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-University of California, Los Angeles Medical Center (G.C.F.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.).
authors.forename: Gillian D
authors.initials: GD
authors.lastname: Sanders
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., A.S.H., A.F.H., E.D.P., G.D.S., S.M.A.-K.); Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC (E.P.Z., A.F.H., E.D.P., S.M.A.-K.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Medicine, Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-University of California, Los Angeles Medical Center (G.C.F.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.).
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (E.P.Z., A.S.H., A.F.H., E.D.P., G.D.S., S.M.A.-K.); Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC (E.P.Z., A.F.H., E.D.P., S.M.A.-K.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.J.S.); Department of Medicine, Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-University of California, Los Angeles Medical Center (G.C.F.); Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, IL (C.W.Y.). alkha001@mc.duke.edu.
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014487:Centers for Medicare and Medicaid Services, U.S.; D016009:Chi-Square Distribution; D057186:Comparative Effectiveness Research; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008390:Markov Chains; D009010:Monte Carlo Method; D011322:Primary Prevention / Q000295:instrumentation*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D016277:Ventricular Function, Left
keywords: comparative effectiveness research; heart failure; implantable cardioverter-defibrillators; morbidity; mortality; women