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Is there a sex bias in implantable cardioverter-defibrillator referral and prescription?
  1. A D Staniforth1,
  2. S C Sporton2,
  3. N M Robinson1,
  4. J Cooper3,
  5. M J Earley1,
  6. A W Nathan1,
  7. R J Schilling1
  1. 1Department of Cardiology, St Bartholomew’s Hospital, London, UK
  2. 2The Heart Hospital, University College London Hospitals NHS Trust, London, UK
  3. 3Centre for Cardiovascular Genetics, Department of Medicine, University College London, London, UK
  1. Correspondence to:
    Dr Andrew D Staniforth
    St Bartholomew’s Hospital, Dominion House, 60 Bartholomew Close, London EC1A 7BE, UK;

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The trandolapril cardiac evaluation (TRACE) investigators reported a male to female ratio of sudden cardiac death (SCD) in coronary disease of 1.4 : 1.1 This confirmed that women with coronary artery disease were at a higher risk of SCD than the Framingham investigators had suggested.2 The low proportion of female subjects undergoing implantable cardioverter-defibrillator (ICD) implantation is well recognised and these data lead us to question whether there could be a sex bias in the referral or prescription of ICDs in patients with coronary artery disease.


We analysed the characteristics of 514 ICD implants performed between January 1990 and October 2002. Early ICD recipients were largely implanted for secondary prevention following aborted SCD. Subsequent implant practice evolved in line with the results of large clinical trials (AVID (anti-arrhythmics versus implantable defibrillators) and MADIT-1 (multicenter automated defibrillator implantation trial)). There was no upper age limit for ICD implantation. Demographic information contained in our ICD database was entered prospectively at the time of implant. All subjects underwent coronary angiography. Ejection fraction was estimated by either echocardiography or left ventricular angiography. Patients were reviewed at ICD clinic visits and therapies were documented as appropriate, inappropriate, or electrical storm following review of stored electrograms. Before the advent of generator electrogram storage, this …

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