Oct. 3, 2007 - A recent study shows that men are 2-3 times more likely than women to receive a defibrillator, an implantable heart device that can prevent sudden cardiac death, even when tests show that women may be at risk. The study was published in the October 3 2007 issue of the Journal of the American Medical Association.
The study first looked at patients on Medicare (65 years or older) who had had a heart attack, heart failure, or cardiomyopathy (disease of the heart muscle) but who had never had a dangerously abnormal heart rhythm or had their heart stop ( cardiac arrest). In these patients, men were more than 3 times as likely as women to receive an ventricular tachycardia (a serious heart rhythm problem). In these patients, men were more than twice as likely as women to have an ICD implanted. Even though defibrillators were used increasingly often in men and women over the course of the 6-year study period, women still had a 75% lower chance of getting the device than men.
The findings are troubling because patients with these conditions, especially those who have already had serious heart rhythm problems, did better when they had an ICD implanted compared with the patients who did not. Patients who already had a heart rhythm problem and received an ICD had a 37% lower chance of dying within a month compared with patients who didn't get an ICD.
It's not clear why doctors were more reluctant to offer ICDs to women than to men. Part of the reason could be that women are typically older than men when their heart problem is diagnosed, or have other characteristics that doctors think make them less eligible for ICD therapy. For example, ICD therapy for the prevention of a cardiac event is especially effective in patients with left ventricular dysfunction, which is more common in men than women. However, this does not explain why women receive an ICD less often than men even when they've already had a serious heart rhythm problem and are clearly at risk for a future problems. According to this study's authors, “the findings highlight the need for an improved understanding of sex differences in patterns of care.”
Be sure to raise your concerns with your doctor if you have concerns about your particular treatment or to find out whether ICD implantation could help protect you.
For more information, see our sections on Heart Failure.
Source: Curtis LH, Al-Khatib SM, Shea AM, Hammill BG, Hernandez AF, Schulman KA. Sex differences in the use of implantable cardioverter-defibrillators for primary and secondary prevention of sudden cardiac death. JAMA. Oct 3 2007;298(13):1517-1524.