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February 6, 2012 (Toronto, Ontario) — Women accustomed an implantable cardioverter-defibrillator (ICD) aloof as generally as men already referred to a specialist, but they were about a third beneath acceptable to again get adapted accessory assay and at decidedly greater accident of above device-related complications, in a -to-be abstraction of >5000 patients from beyond Ontario [1]. Bloodshed was about the aforementioned in both groups.
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The allegation should add to accepted misgivings about whether primary-prevention ICD break based primarily on ventricular function, acquired from a alternation of above trials that included predominantly men, should additionally administer to women.
"Our abstracts would advance that conceivably the means that we're abutting sudden-death accident stratification may not absolutely administer to women," chief columnist Dr Douglas S Lee (University of Toronto, ON) told heartwire .
"I anticipate we charge to go aback to the cartoon lath in women. While casting atom may be a actual almighty augur of cast in men, in women it may not be the best predictor." Further mechanistic studies are bare to acquisition bigger ones, he said.
The assay is appear online today in the Annals of Internal Medicine, with aboriginal columnist Dr Derek R MacFadden (University of Toronto).
One abeyant annual for the study's after-effects could be the greater allowances women assume to acquire from cardiac resynchronization assay (CRT) compared with men, including added advance in ventricular adjustment and cardiac function. That, on its own, could conceivably abate the likelihood of adapted ICD therapy. And added women than men had CRT-capable defibrillators (CRT-D): 30.1% vs 22.7% of men (<0.001). The butt accustomed dual- or single-chamber ICDs.
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But, Lee said, "We adapted for those differences in our analysis. So it doesn't assume to be the accessory itself that explains the aberration in adapted shock rate."
The accumulation prospectively followed 5450 patients who accustomed primary- or secondary-prevention ICDs from 2007 to 2010 at all 18 ICD-authorized centers in Ontario; 21.2% were women.
Those women showed decidedly bargain adapted risks of adapted shocks, as able-bodied as of adapted shocks or antitachycardia pacing (ATP), compared with the men. The risks of inappropriate shocks were similar, as was mortality.
Hazard Ratio (95% CI)* for Accessory and Analytic Outcomes, Women vs Men
*Adjusted for age, QRS duration, creatinine, hemoglobin, claret pressure, NYHA class, VT/VF or nonsustained VT, MI, above-mentioned PCI or CABG, affection failure, ancestors history, atrial fibrillation, valvular affection disease, syncope, dyslipidemia, diabetes, hypertension, antecedent achievement or brief ischemic attack, borderline vascular disease, abiding adverse lung disease, LVEF, and CRT vs dual-chamber vs single-chamber ICD
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ICD-10 Transition: What Health Lawyers Need to Know | pvd icd 10[/caption]
Women were additionally decidedly added acceptable to accept above complications at both 45 canicule (p=0.002) and one year (p<0.001) and to accept any affectionate of complication, additionally afterwards both aftereffect times (p=0.006 and p<0.001, respectively).
Major complications that were decidedly added accepted in women than men included advance backup and pulmonary edema; accessory ones included advance boot not arch to afterlight and subclavian venous thrombosis.
Hazard Ratio (95% CI) for Complications by Aftereffect Time, Women vs Men
Adjusted for age, QRS duration, creatinine, hemoglobin, claret pressure, NYHA class, VT/VF or nonsustained VT, MI, above-mentioned PCI or CABG, affection failure, ancestors history, atrial fibrillation, valvular affection disease, syncope, dyslipidemia, diabetes, hypertension, antecedent achievement or brief ischemic attack, borderline vascular disease, abiding adverse lung disease, LVEF, and CRT vs dual-chamber vs single-chamber ICD
He and his colleagues speculated on what ability annual for the altered ante of adapted accessory therapy. They adapted for medications, so it apparently wasn't that women had added able pharmacologic therapy. But there could be physiologic differences that affect the accident of austere ventricular arrhythmia, such as aberration in myocardial advice or repolarization or in "autonomic responses to astute coronary occlusion," they write.
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Whatever the reason, "both physicians and patients should accede the lower amount of adapted ICD-delivered assay and college aggravation ante in women back chief on defibrillator implantation," the aftereffect of which appears to be beneath accepted account from ICDs compared with men.
An accompanying beat additionally mulls whether the allegation axis from biological or analytic differences amid the sexes [2]. According to Drs Pamela S Douglas and Lesley H Curtis (Duke University Medical Center, Durham, NC), the after-effects "raise the arresting catechism of whether accepted differences in the basal analysis of cardiac arrhythmias amid men and women, such as the college prevalence of nonischemic cardiomyopathy as a account of abrupt death, and the greater use of accessory CRT ability accord to the botheration and, if so, whether sex-specific approaches to ICD use, programming, or added factors ability aerate account and abbreviate harms in women."
They continue, "Higher aggravation ante accommodate an absorbing clue on how ICD assay ability alter amid men and women and alarm to apperception the college procedural aggravation ante acclaimed in women who accustomed PCI with aboriginal technology; these ante bigger with later-generation devices. The affinity is absolutely apart but, if it holds, suggests that altered anatomy sizes crave altered advance technology, an advance that would be accepted to account men of abbreviate ability as able-bodied as women."
The abstraction was adjourned by the Canadian Institutes of Health Research and Ontario Ministry of Health and Long-Term Care. For disclosures, the affidavit accredit the clairvoyant actuality for columnist conflicts of absorption and actuality for the editorialists.
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