Sex‐based differences in cardiac resynchronization therapy upgrade and outcome for patients with pacemaker and new‐onset heart failure

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Abstract

Background
Patients with chronic right ventricular (RV) pacing are at an increased risk of heart failure. Previous studies have indicated that cardiac resynchronization therapy (CRT) is underused in this setting, and that there may be sex-based differences in both CRT use and clinical outcome.

Objective
To evaluate sex-based differences in CRT use and clinical outcome for patients with new-onset heart failure post RV pacing.

Methods
Data from the Swedish pacemaker registry was matched with data from the national death and disease registries. Patients with de novo pacemaker implant due to AV block during the period 2005–2020 were included. New-onset heart-failure within two years post-implant was evaluated, primary outcome was all-cause mortality.

Results
In all, 30183 patients (37% female) were included. Women were on average 3 years older, but had less comorbidities than men. Median follow-up time was 4.5 [2.0–8.0] years. Women had better age- and comorbidity-adjusted survival (HR 0.78 [0.73–0.84], p < .001). For the 3560 patients (12.4% men and 10.7% women, p < .001) who were diagnosed with new-onset heart failure, 5-year mortality was similar for men and women (50% vs. 48%, p = .29). However, women were less likely to receive CRT-upgrade (3.8% vs. 9.1%, p < .001), and those who did were almost ten years younger than the men.

Conclusion
Women with pacemaker due to AV block are older but have less comorbidities than men. They are less likely to develop new-onset heart failure, but also less likely to receive a CRT upgrade if they do develop heart failure. Increased awareness of the positive effects of CRT upgrade and potential sex- and age-based discrimination is warranted.
Original languageEnglish
Pages (from-to)1-9
JournalPACE - Pacing and Clinical Electrophysiology
DOIs
Publication statusPublished - 2023 Oct 10

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems

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