title: Increasing sex differences in the use of cardiac resynchronization therapy with or without implantable cardioverter-defibrillator.
abstract: OBJECTIVE
  Previous studies have identified sex disparities in the use of cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD), although the basis of underutilization in women remains poorly understood. The aim of this study was to assess sex differences in patterns of CRT use with our without ICD.
  
  
  RESULTS
  In this cross-sectional study using the National Inpatient Sample database we identified 311 009 patients undergoing CRT implantation in the United States between 2006 and 2012. Demographic and clinical characteristics were compared between men and women undergoing CRT implantation, with special attention to clinical predictors of left ventricular reverse remodelling (CRT response, score range: 0-4) and reduced ICD efficacy (score range: 0-7). When compared to men, women undergoing CRT implantation were significantly more likely to have ≥ 3 predictors of CRT response (47.3 vs. 33.2%, P < 0.001) and less likely to have ≥3 predictors of reduced ICD efficacy (27.0 vs. 37.3%, P < 0.001). Despite this, men were significantly more likely to undergo CRT with ICD (CRT-D) as the type of CRT (88.6 vs. 80.1% of all CRT implants). Compared to those with the greatest likelihood of CRT response (score ≥ 3), those with the least likelihood of CRT response had a significant decreased odds of CRT-D implant (adj odds ratio 0.27 [0.24-0.31], P < 0.001), with a greater decreased odds in women compared to men (P, for sex interaction <0.001). The difference in the % of CRT-D implant in men vs. women increased over the study period (P, sex Δ time trend = 0.012).
  
  
  CONCLUSIONS
  In this large, contemporary cohort, sex differences in CRT-D implantation were inversely related to predicted CRT efficacy and have increased over time. Future efforts to narrow the gap in CRT-D implantation in men and women may help better align device selection with those most likely to benefit.
authors.affiliation: Cardiac Arrhythmia Service and Division of Cardiology, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Neal A
authors.initials: NA
authors.lastname: Chatterjee
authors.affiliation: Department of Cardiology, Lund University, Skane University Hospital, SE-221 85, Lund, Sweden.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Borgquist
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA.
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lewey
authors.affiliation: Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Vicki A
authors.initials: VA
authors.lastname: Jackson
authors.affiliation: Cardiac Arrhythmia Service and Division of Cardiology, GRB 109, Massachusetts General Hospital Heart Center, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Jagmeet P
authors.initials: JP
authors.lastname: Singh
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Metlay
authors.affiliation: Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston MA 02215, USA.
authors.forename: Charlotta
authors.initials: C
authors.lastname: Lindvall
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D017147:Defibrillators, Implantable; D005260:Female; D054625:Healthcare Disparities; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Cardiac resynchronization therapy ; Implantable cardioverter-defibrillator ; Sex disparities