Introduction: The prevalence of heart failure (HF) significantly increases with age especially in women, who are more frequently hospitalized for this condition than men. Despite epidemiological data and the results of some studies showing that implantable cardiac defibrillator (ICD) can be particularly useful in women, undertreatment still represents a significant problem in female gender. Aims of this research were to analyze the age-related characteristics of women who underwent ICD implantation in a large Italian database and to define the predictors of mortality during the follow-up.Methods: In the Italian ClinicalService Multicenter Observational Project, 6311 patients receiving an ICD between 2004 and 2011 were included in 117 centers. Women were 1102 (17.5% of the whole population) and were divided into 3 groups (<65: N=413, 65-74: N=416, ≥75 years: N=273). We evaluated age-related differences in baseline clinical characteristics and, then, we compared survival between women < and ≥75 years during a 27-month follow-up.Results: Age in the three groups was 55±9, 70±3 and 78±3 years, respectively. Coronary artery disease (CAD; 25, 32, 45%), chronic renal failure (CRF; 5, 6, 11%), COPD, diabetes and hypertension steadily grew with age (all p≤0.001). EF was severely reduced in every group (30±12, 28±7 and 30±10, p=0.008), with NYHA III-IV Class more represented among elderly women (52, 58, 62%, p<0.001). Beta-blockers were less often prescribed at advanced age (87, 81, 79%, p=0.022) and CRT-D more often used in subjects ≥65 years (64, 79, 71%, p=0.002). During the follow-up, mortality was significantly higher in older women (5, 7, 12%, p<0.001). Age-group (HR=1.47, p=0.033), CAD (HR=2.98, p<0.001) and the presence of CRF (HR=2.93, p=0.006) were multivariate predictors of prognosis in our group of women with an ICD. CAD (HR=3.45, p<0.001) and CRF (HR=4.14, p=0.004) were independently associated with prognosis also in <75 years patients, while no predictors were found for elderly women.Conclusions: Women presently represent <20% of patients receiving an ICD. Age, CAD and CRF negatively influence survival in this population. However, in older women, traditional risk factors seem to lose their importance.
Women and ICD: The Influence of Age and Clinical Characteristics on Survival; the Experience of the Italian ClinicalService Multicenter Observational Project / Fumagalli, S., Padeletti, L., Marchionni, N., Lunati, M., Proclemer, A., Boriani, G., Landolina, M., Ricci, R.P., Gasparini, M.. - In: CIRCULATION. - ISSN 0009-7322. - ELETTRONICO. - 132:(2015), pp. 13906-13906.
Women and ICD: The Influence of Age and Clinical Characteristics on Survival; the Experience of the Italian ClinicalService Multicenter Observational Project
Fumagalli, S
;Padeletti, L;Marchionni, N;Lunati, M;
2015
Abstract
Introduction: The prevalence of heart failure (HF) significantly increases with age especially in women, who are more frequently hospitalized for this condition than men. Despite epidemiological data and the results of some studies showing that implantable cardiac defibrillator (ICD) can be particularly useful in women, undertreatment still represents a significant problem in female gender. Aims of this research were to analyze the age-related characteristics of women who underwent ICD implantation in a large Italian database and to define the predictors of mortality during the follow-up.Methods: In the Italian ClinicalService Multicenter Observational Project, 6311 patients receiving an ICD between 2004 and 2011 were included in 117 centers. Women were 1102 (17.5% of the whole population) and were divided into 3 groups (<65: N=413, 65-74: N=416, ≥75 years: N=273). We evaluated age-related differences in baseline clinical characteristics and, then, we compared survival between women < and ≥75 years during a 27-month follow-up.Results: Age in the three groups was 55±9, 70±3 and 78±3 years, respectively. Coronary artery disease (CAD; 25, 32, 45%), chronic renal failure (CRF; 5, 6, 11%), COPD, diabetes and hypertension steadily grew with age (all p≤0.001). EF was severely reduced in every group (30±12, 28±7 and 30±10, p=0.008), with NYHA III-IV Class more represented among elderly women (52, 58, 62%, p<0.001). Beta-blockers were less often prescribed at advanced age (87, 81, 79%, p=0.022) and CRT-D more often used in subjects ≥65 years (64, 79, 71%, p=0.002). During the follow-up, mortality was significantly higher in older women (5, 7, 12%, p<0.001). Age-group (HR=1.47, p=0.033), CAD (HR=2.98, p<0.001) and the presence of CRF (HR=2.93, p=0.006) were multivariate predictors of prognosis in our group of women with an ICD. CAD (HR=3.45, p<0.001) and CRF (HR=4.14, p=0.004) were independently associated with prognosis also in <75 years patients, while no predictors were found for elderly women.Conclusions: Women presently represent <20% of patients receiving an ICD. Age, CAD and CRF negatively influence survival in this population. However, in older women, traditional risk factors seem to lose their importance.
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