Sex disparities in the choice of cardiac resynchronization therapy device utilized: an analysis of trends, predictors and outcomes.

Abstract Background There is limited evidence on the influence of sex on decision to implant a cardiac resynchronization therapy device with pacemaker (CRT-P) or defibrillator (CRT-D), and the existence of sex-dependent differences in complications that may bias this decision. Methods All patients undergoing de novo CRT implantation (2004-2014) in the United States (US) National Inpatient Sample were included, stratified by device type (CRT-P and CRT-D). Multivariable logistic regression models were conducted to assess the association of female sex with receipt of CRT-D, and periprocedural complications. Results Out of 400,823 weighted CRT procedural records, the overall percentages of females undergoing CRT-P and CRT-D implantations were 41.5% and 27.8%, respectively, and these increased in comparison to males over the study period. Females were less likely to receive CRT-D (OR 0.66 95% confidence interval (CI) 0.64-0.67) and this trend remained stable throughout the study period (p=0.06). Furthermore, females were associated with increased odds of procedure-related complications (bleeding, thoracic and cardiac), compared to men, in the CRT-D group but not in the CRT-P group. Factors such as atrial fibrillation, malignancies, renal failure, advanced age (>60 years) and admission to non-urban/small hospitals favored the receipt of CRT-P over CRT-D whereas history of ischemic heart disease, cardiac arrest or ventricular arrhythmias favored the receipt of CRT-D over CRT-P. Conclusion Females were associated with persistently reduced odds of receipt of CRT-D compared to males over an eleven-year period. The present study identifies important factors that predict the choice of CRT device offered to patients in the US.