title: Sex-specific outcomes with addition of defibrillation to resynchronisation therapy in patients with heart failure.
abstract: Among primary prevention patients with heart failure receiving cardiac resynchronisation therapy (CRT), the impact of additional implantable cardioverter defibrillator (ICD) treatment on outcomes and its interaction with sex remains uncertain. We aim to assess whether the addition of the ICD functionality to CRT devices offers a more pronounced survival benefit in men compared with women, as previous research has suggested.
  
  
  
  Observational multicentre cohort study of 5307 consecutive patients with ischaemic or non-ischaemic dilated cardiomyopathy and no history of sustained ventricular arrhythmias having CRT implantation with (cardiac resynchronisation therapy defibrillator (CRT-D), n=4037) or without (cardiac resynchronisation therapy pacemaker (CRT-P), n=1270) defibrillator functionality. Using propensity score (PS) matching and weighting and cause-of-death data, we assessed and compared the outcome of patients with CRT-D versus CRT-P. This analysis was stratified according to sex.
  
  
  
  After a median follow-up of 34 months (interquartile range 22-60 months) no survival advantage, of CRT-D versus CRT-P was observed in both men and women after PS matching (HR=0.95, 95% CI 0.77 to 1.16, p=0.61, and HR=1.30, 95% CI 0.83 to 2.04, p=0.25, respectively). With inverse-probability weighting, a benefit of CRT-D was seen in male patients (HR 0.78, 95% CI 0.65 to 0.94, p=0.012) but not in women (HR 0.87, 95% CI 0.63 to 1.19, p=0.43). The excess unadjusted mortality of patients with CRT-P compared with CRT-D was related to sudden cardiac death in 7.4% of cases in men but only 2.2% in women.
  
  
  
  In primary prevention patients with CRT indication, the addition of a defibrillator might convey additional benefit only in well-selected male patients.
authors.affiliation: Cardiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Barra
authors.affiliation: Barts Heart Centre, Barts Health NHS Trust, London, UK.
authors.forename: Rui
authors.initials: R
authors.lastname: Providência
authors.affiliation: Cardiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Duehmke
authors.affiliation: Cardiology Department, Clinique Pasteur, Toulouse, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Boveda
authors.affiliation: Cardiology Department, European Georges Pompidou Hospital, Paris, France.
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.affiliation: Arrhythmia Clinic, Lund University, Skane University Hospital, Lund, Sweden.
authors.forename: Christian
authors.initials: C
authors.lastname: Reitan
authors.affiliation: Arrhythmia Clinic, Lund University, Skane University Hospital, Lund, Sweden.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Borgquist
authors.affiliation: Cardiology Department, Lille University Hospital, Lille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
authors.affiliation: Cardiology Department, Grenoble University Hospital, Grenoble, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Defaye
authors.affiliation: Cardiology Department, Nancy University Hospital, Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sadoul
authors.affiliation: Cardiology Department, Marseille University Hospital, Marseille, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Deharo
authors.affiliation: Cardiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
authors.forename: Iannish
authors.initials: I
authors.lastname: Sadien
authors.affiliation: Barts Heart Centre, Barts Health NHS Trust, London, UK.
authors.forename: Kiran
authors.initials: K
authors.lastname: Patel
authors.affiliation: Green Lane Cardiovascular Services, Level 3, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Khang-Li
authors.initials: KL
authors.lastname: Looi
authors.affiliation: Cardiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
authors.forename: David
authors.initials: D
authors.lastname: Begley
authors.affiliation: Barts Heart Centre, Barts Health NHS Trust, London, UK.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Chow
authors.affiliation: Cardiology Department, European Georges Pompidou Hospital, Paris, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Le Heuzey
authors.affiliation: Cardiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
authors.forename: Sharad
authors.initials: S
authors.lastname: Agarwal
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control; D004554:Electric Countershock / Q000379:methods*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left