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Sex-specific outcomes with addition of defibrillation to resynchronisation therapy in patients with heart failure
  1. Sérgio Barra1,
  2. Rui Providência2,
  3. Rudolf Duehmke1,
  4. Serge Boveda3,
  5. Eloi Marijon4,
  6. Christian Reitan5,
  7. Rasmus Borgquist5,
  8. Didier Klug6,
  9. Pascal Defaye7,
  10. Nicolas Sadoul8,
  11. Jean-Claude Deharo9,
  12. Iannish Sadien1,
  13. Kiran Patel2,
  14. Khang-Li Looi10,
  15. David Begley1,
  16. Anthony W Chow2,
  17. Jean-Yves Le Heuzey4,
  18. Sharad Agarwal1
  19. On Behalf of the French-UK-Sweden CRT Network
  1. 1Cardiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK
  2. 2Barts Heart Centre, Barts Health NHS Trust, London, UK
  3. 3Cardiology Department, Clinique Pasteur, Toulouse, France
  4. 4Cardiology Department, European Georges Pompidou Hospital, Paris, France
  5. 5Arrhythmia Clinic, Lund University, Skane University Hospital, Lund, Sweden
  6. 6Cardiology Department, Lille University Hospital, Lille, France
  7. 7Cardiology Department, Grenoble University Hospital, Grenoble, France
  8. 8Cardiology Department, Nancy University Hospital, Nancy, France
  9. 9Cardiology Department, Marseille University Hospital, Marseille, France
  10. 10Green Lane Cardiovascular Services, Level 3, Auckland City Hospital, Auckland, New Zealand
  1. Correspondence to Dr Sérgio Nuno Craveiro Barra, Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK; sergioncbarra{at}


Objective Among primary prevention patients with heart failure receiving cardiac resynchronisation therapy (CRT), the impact of additional implantable cardioverter defibrillator (ICD) treatment on outcomes and its interaction with sex remains uncertain. We aim to assess whether the addition of the ICD functionality to CRT devices offers a more pronounced survival benefit in men compared with women, as previous research has suggested.

Methods Observational multicentre cohort study of 5307 consecutive patients with ischaemic or non-ischaemic dilated cardiomyopathy and no history of sustained ventricular arrhythmias having CRT implantation with (cardiac resynchronisation therapy defibrillator (CRT-D), n=4037) or without (cardiac resynchronisation therapy pacemaker (CRT-P), n=1270) defibrillator functionality. Using propensity score (PS) matching and weighting and cause-of-death data, we assessed and compared the outcome of patients with CRT-D versus CRT-P. This analysis was stratified according to sex.

Results After a median follow-up of 34 months (interquartile range 22–60 months) no survival advantage, of CRT-D versus CRT-P was observed in both men and women after PS matching (HR=0.95, 95% CI 0.77 to 1.16, p=0.61, and HR=1.30, 95% CI 0.83 to 2.04, p=0.25, respectively). With inverse-probability weighting, a benefit of CRT-D was seen in male patients (HR 0.78, 95% CI 0.65 to 0.94, p=0.012) but not in women (HR 0.87, 95% CI 0.63 to 1.19, p=0.43). The excess unadjusted mortality of patients with CRT-P compared with CRT-D was related to sudden cardiac death in 7.4% of cases in men but only 2.2% in women.

Conclusions In primary prevention patients with CRT indication, the addition of a defibrillator might convey additional benefit only in well-selected male patients.

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  • Contributors Conceived and designed the research: SB, RP, SB, EM and SA conceived this specific study. DK, PD, NS, J-CD, RB, AWC and J-YLH conceived other studies from which patients were derived. Performed statistical analysis: SB, RP. Handled funding and supervision: SB, EM, RB, DB, AWC, J-YLH, SA. Acquired the data: SB, RP, RD, SB, EM, CR, DK, PD, NS, J-CD, IS, KP, K-LL, SA. Drafted the manuscript: SB, RP, RD, EM. Made critical revision of the manuscript for key intellectual content: all authors.

  • Competing interests None declared.

  • Ethics approval The data collection and analysis were approved by the individual sites’ institutional review board or ethics committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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