Cardiac resynchronisation therapy twice as effective in women

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A recently sub-analysis of the MADIT-CRT (Multicenter automatic defibrillator implantation with cardiac resynchronization therapy) trial shows women obtain significantly greater reductions in death or heart failure, heart failure alone, and all-cause mortality with cardiac resynchronisation therapy than men. The results were recently published in the Journal of American College of Cardiology.

A recently sub-analysis of the MADIT-CRT (Multicenter automatic defibrillator implantation with cardiac resynchronization therapy) trial shows women obtain significantly greater reductions in death or heart failure, heart failure alone, and all-cause mortality with cardiac resynchronisation therapy than men. The results were recently published in the Journal of American College of Cardiology.

Overall, female patients had a better result from cardiac resynchronisation therapy with defibrillator than male patients with a significant 69% reduction in death or heart failure (hazard ratio 0.31, p<0.001) and 70% reduction in heart failure alone (hazard ratio0.30, p<0.001) compared to 35% for men. Women also had a significant 72% reduction in all-cause mortality in the total population (hazard ratio 0.28,p=0.02).

All patients (453 female and 1,367 male) enrolled in the MADIT-CRT trial were included in the sex-specific outcome analysis comparing the effect of cardiac resynchronisation therapy with defibrillator relative to implanted cardioverter-defibrillatoron death or heart failure, heart failure only, and death at any time.

The beneficial effects of cardiac resynchronisation therapy with defibrillator among women were associated with consistently greater echocardiographic evidence of reverse cardiac remodelling in women than in men, investigators found.

MADIT-CRT is the world’s largest randomised cardiac resynchronisation therapy with defibrillator study of 1,820 New York Heart Association class I and II patients enrolled at 110 centres worldwide. Results of the trial were published in the New England Journal of Medicine in October 2009.

“There are a number of factors that may explain why women experienced a greater benefit than men. Cardiac resynchronisation therapy with defibrillator is designed to improve the heart’s overall pumping ability and women are more likely than men to have non-ischaemic heart disease. Men are more likely to have ischaemic heart disease, also known as coronary artery disease, which often leads to a more localised impact on the heart”, said Arthur Moss, University of Rochester, New York, USA, principal investigator of the MADIT-CRT trial.

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