Canadian Journal of Cardiology

Trends of Sex Differences in Outcomes of Cardiac Electronic Device Implantations in the United States

Published:August 22, 2019DOI:



      The disparity in outcomes of cardiac electronic device implantations between sexes has been previously demonstrated in device-specific cohorts (eg, implantable cardioverter-defibrillators [ICDs]). However, it is unclear whether sex differences are present with all types of cardiac implantable electronic devices (CIEDs) and, if so, what the trends of such differences have been in recent years.


      With the use of the National Inpatient Sample, all hospitalizations from 2004 to 2014 for de novo implantation of permanent pacemakers, cardiac resynchronization therapy with or without a defibrillator, and ICDs were analyzed to examine the association between sex and in-hospital acute complications of CIED implantation.


      Out of 2,815,613 hospitalizations for de novo CIED implantation, 41.9% were performed on women. Women were associated with increased adjusted odds (95% confidence interval) of adverse procedural complications (major adverse cardiovascular complications: 1.17 [1.16-1.19]; bleeding: 1.13 [1.12-1.15],-thoracic: 1.42 [1.40-1.44]; cardiac: 1.44 [1.38-1.50]), whereas the adjusted odds of in-hospital all-cause mortality compared with men was 0.96 (0.94-1.00). The odds of adverse complications in the overall CIED cohort were persistently raised in women throughout the study period, whereas similar odds of all-cause mortality across the sexes were observed throughout the study period.


      In a national cohort of CIED implantations we demonstrate that women are at an overall higher risk of procedure-related adverse events compared with men, but not at increased risk of all-cause mortality. Further studies are required to identify procedural techniques that would improve outcomes among women undergoing such procedures.



      La disparité des résultats de l’implantation d’un dispositif cardiaque électronique chez les hommes et chez les femmes a déjà été démontrée dans des cohortes de sujets ayant reçu un dispositif particulier (p. ex. un défibrillateur cardioverteur implantable [DCI]). On ne sait toutefois pas s’il existe une telle différence entre les hommes et les femmes pour tous les types de dispositifs cardiaques électroniques implantables (DCEI) et, s’il y en a une, quelles ont été les tendances à cet égard au cours des dernières années.


      À l’aide de la base de données NIS (National Inpatient Sample) des États-Unis, nous avons analysé toutes les hospitalisations qui ont eu lieu de 2004 à 2014 pour l’implantation de novo d’un stimulateur cardiaque permanent, un traitement de resynchronisation cardiaque avec ou sans défibrillateur ou la pose d’un DCI afin de déterminer s’il existe une association entre le sexe du patient et les complications aiguës liées à l’hospitalisation pour l’implantation d’un DCEI.


      Des 2 815 613 patients hospitalisés pour l’implantation de novo d’un DCEI, 41,9 % étaient des femmes. Le fait d’être une femme a été associé à une hausse de la cote corrigée (intervalle de confiance à 95 %) exprimant le risque de complications liées à l’intervention (complications cardiovasculaires majeures : 1,17 [de 1,16 à 1,19]; hémorragie : 1,13 [de 1,12 à 1,15]; complications thoraciques : 1,42 [de 1,40 à 1,44]; complications cardiaques : 1,44 [de 1,38 à 1,50]), tandis que la cote corrigée exprimant le risque de mortalité toutes causes confondues durant l’hospitalisation chez les femmes comparativement aux hommes était de 0,96 (de 0,94 à 1,00). Le risque de complications dans l’ensemble de la cohorte des patients ayant reçu un DCEI était systématiquement supérieur chez les femmes durant toute la période étudiée, tandis que le risque de mortalité toutes causes confondues était comparable chez les femmes et chez les hommes.


      L’analyse d’une cohorte nationale de sujets ayant reçu un DCEI a révélé que les femmes sont exposées à un risque global de complications liées à l’intervention plus élevé que les hommes, mais pas à un risque accru de mortalité toutes causes confondues. D’autres études s’imposent pour déterminer les techniques d’intervention susceptibles d’améliorer les résultats chez les femmes qui subissent de telles interventions.
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      Linked Article

      • Sex Differences in Complications and Outcomes of Cardiac Implantable Electronic Devices: Time to Evaluate Our Practice
        Canadian Journal of CardiologyVol. 36Issue 1
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          Cardiac implantable electronic devices (CIEDs) improve symptoms and quality of life, and reduce death from heart failure or arrhythmias. Approximately 200,000 Canadians are living with one of these devices.1 Although there is overwhelming evidence to support their value, there is evidence of considerable variability in their use, benefits, and adverse outcomes. The study by Mohamed et al.,2 in this edition of the Journal, entitled “Trends in Sex Differences in Outcomes of Cardiac Electronic Device Implantations in the United States,” explores this variability for permanent pacemakers (PPMs), cardiac resynchronization therapy (CRT), and implantable cardioverter defibrillators (ICDs) through the lens of sex differences in a fairly contemporary national cohort.
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