Gender Differences in Appropriate Shocks and Mortality among Patients with Primary Prophylactic Implantable Cardioverter-Defibrillators: Systematic Review and Meta-Analysis.
BACKGROUND
Some but not all prior studies have shown that women receiving a primary prophylactic implantable cardioverter defibrillator (ICD) have a lower risk of death and appropriate shocks than men.


OBJECTIVE
To evaluate the effect of gender on the risk of appropriate shock, all-cause mortality and inappropriate shock in contemporary studies of patients receiving a primary prophylactic ICD.


METHODS
PubMed, LIVIVO, Cochrane CENTRAL between 2010 and 2016.


METHODS
Studies providing at least 1 gender-specific risk estimate for the outcomes of interest.


METHODS
Abstracts were screened independently for potentially eligible studies for inclusion. Thereby each abstract was reviewed by at least two authors.


RESULTS
Out of 680 abstracts retained by our search strategy, 20 studies including 46'657 patients had gender-specific information on at least one of the relevant endpoints. Mean age across the individual studies varied between 58 and 69 years. The proportion of women enrolled ranged from 10% to 30%. Across 6 available studies, women had a significantly lower risk of first appropriate shock compared with men (pooled multivariable adjusted hazard ratio 0.62 (95% CI [0.44; 0.88]). Across 14 studies reporting multivariable adjusted gender-specific hazard ratio estimates for all-cause mortality, women had a lower risk of death than men (pooled hazard ratio 0.75 (95% CI [0.66; 0.86]). There was no statistically significant difference for the incidence of first inappropriate shocks (3 studies, pooled hazard ratio 0.99 (95% CI [0.56; 1.73]).


CONCLUSIONS
Individual patient data were not available for most studies.


CONCLUSIONS
In this large contemporary meta-analysis, women had a significantly lower risk of appropriate shocks and death than men, but a similar risk of inappropriate shocks. These data may help to select patients who benefit from primary prophylactic ICD implantation.
Division of Internal Medicine, Department of Medicine, University Hospital Basel, Basel, Switzerland.
David
D
Conen
Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.
Barbora
B
Arendacká
Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.
Christian
C
Röver
Department of Cardiology and Pulmonology and Clinical Electrophysiology Division, University Medical Center Göttingen, Göttingen, Germany.
Leonard
L
Bergau
Department of Cardiology and Pulmonology and Clinical Electrophysiology Division, University Medical Center Göttingen, Göttingen, Germany.
Pascal
P
Munoz
Department of Physiology and Cardiology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands.
Sofieke
S
Wijers
Division of Cardiology, Department of Medicine, University Hospital Basel, Basel, Switzerland.
Christian
C
Sticherling
Department of Cardiology and Pulmonology and Clinical Electrophysiology Division, University Medical Center Göttingen, Göttingen, Germany.
Markus
M
Zabel
Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.|German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany.
Tim
T
Friede
D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D012737:Sex Factors