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Implantable Cardioverter-Defibrillators in Women FREE

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The full report is titled “Sex Differences in Implantable Cardioverter-Defibrillator Outcomes: Findings From a Prospective Defibrillator Database.” It is in the 7 February 2012 issue of Annals of Internal Medicine (volume 156, pages 195-203). The authors are D.R. MacFadden, E. Crystal, A.D. Krahn, I. Mangat, J.S. Healey, P. Dorian, D. Birnie, C.S. Simpson, Y. Khaykin, A. Pinter, K. Nanthakumar, A.J. Calzavara, P.C. Austin, J.V. Tu, and D.S. Lee.

Ann Intern Med. 2012;156(3):I-30. doi:10.7326/0003-4819-156-3-201202070-00002
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What is the problem and what is known about it so far?

Implantable cardioverter-defibrillators (ICDs) are battery-powered devices that are placed under the skin of patients with certain heart problems. They are recommended for some men and women who have had cardiac arrest or who have severely reduced heart function. Once implanted, the ICD can deliver electrical shocks as needed to treat abnormal and dangerous patterns in the heart's electrical system. Whether ICDs are used at similar rates and result in similar outcomes among women and men are not known.

Why did the researchers do this particular study?

To find out whether women receive ICDs as often as men and whether they experience the same benefits or harms as men once the ICD is in place.

Who was studied?

6021 women and men in Ontario, Canada, who were referred to cardiologists who specialize in ICD placement.

How was the study done?

In Ontario, information about any patient referred to a cardiology specialist for consideration of an ICD must be entered into a database that is maintained by the government. The authors used information from this database to analyze how often women and men received an ICD after being referred to a cardiology specialist, as well as information about problems that occurred after ICD placement and whether the patients ever received electrical shocks for treatment.

What did the researchers find?

Women were just as likely as men to receive an ICD if they were referred to a cardiology specialist. After placement of the ICD, some women and men had complications; however, these complications occurred more often in women than in men. The most common problem seen in women was movement of the electrical leads of the ICD, which sometimes required the cardiologists to reposition them to ensure appropriate function. One year after ICD placement, women were less likely to have ever received a shock from the ICD to treat an abnormal or a dangerous pattern in the heart's electrical system.

What were the limitations of the study?

The researchers could not determine whether doctors used different criteria for referring men and women to cardiologist specialists for ICD placement.

What are the implications of the study?

The risks and benefits of ICD placement may not be the same for women as for men. More studies are needed to better assess which patients are most likely to receive the greatest benefit and least harm from ICDs.





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