Sex differences in Cardiac electronic device implantation: Outcomes from an Australian multi-centre clinical quality registry

David Eccleston; Daniel Cehic; Glenn Young; Tina Lin; Steven Pavia; Enayet K Chowdhury; Christopher Reid; Danny Liew; Ben King; Isabel Tan; Karen Phillips; David O'Donnell; GenesisCare Outcomes Registry Investigators

doi:10.1016/j.ijcha.2021.100828

Sex differences in Cardiac electronic device implantation: Outcomes from an Australian multi-centre clinical quality registry

Int J Cardiol Heart Vasc. 2021 Jun 23:35:100828. doi: 10.1016/j.ijcha.2021.100828. eCollection 2021 Aug.

Authors

David Eccleston^{1

2}, Daniel Cehic³, Glenn Young³, Tina Lin¹, Steven Pavia⁴, Enayet K Chowdhury^{2

5}, Christopher Reid^{2

5}, Danny Liew², Ben King⁶, Isabel Tan⁶, Karen Phillips⁴, David O'Donnell¹; GenesisCare Outcomes Registry Investigators

Affiliations

¹ Warringal Private Hospital, Melbourne, Australia.
² School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
³ Wakefield Hospital, Adelaide, Australia.
⁴ Wesley Hospital, Brisbane, Australia.
⁵ Curtin University, Perth, Australia.
⁶ Mount Hospital, Perth, Australia.

Abstract

Background: There is uncertainty regarding whether outcomes after Cardiac Implantable Electronic Devices (CIED) differ between women and men. There are no prospectively collected data regarding Australian CIED outcomes. This study aimed to determine whether the characteristics and outcomes of Australian patients undergoing CIED implantation differ by sex.

Methods: We prospectively followed 5,360 patients undergoing CIED implantation between 2015 and 2019 in a large multi-centre Australian registry. Patient characteristics, procedural data, medications and clinical outcomes to 1 year were analysed.

Results: The mean age was 76.2 + 11.2 years, and 2022 (37.7%) were female. Women were older than men at device implantation (77.0 ± 11.6 years vs. 75.5 ± 10.9 years, p < 0.001). Most implants were de novo (79.7%). Pacing was more commonly for sick sinus syndrome in women than men (54.4% vs. 47.2%, p < 0.001) and less often for A-V block (28.3% vs. 35.1%, p < 0.001). Adverse events at 30 days were low compared to international cohorts, for mortality (0.06%) and major complications (0.6%). There were no significant sex differences (women vs. men) for death (HR 1.33, 95% CI 0.58-3.13, p = 0.49) or major complications (HR 1.41, 95% 95% CI 0.65-3.03, p = 0.39). At 1-year, there was no difference in major complications or risk-adjusted all-cause mortality (HR 1.05, 95% CI 0.70-1.29, p = 0.77) between women and men.

Conclusions: Clinical practice and 30-day outcomes after CIED implantation in Australia are consistent with international reports. There were no differences in procedural complication rates or clinical outcomes at 1-year between women and men, regardless of age or CIED system implanted.

Keywords: A-V, Atrio-ventricular; AF, Atrial fibrillation; CABG, Coronary artery bypass graft; CIED, Cardiac implantable electronic device; CRT-P, Cardiac Resynchronisation therapy pacemaker; Cardiac Implantable Electronic Device; DDD, Dual chamber sensing and pacing; EPS, Electrophysiological study; GCOR, GenesisCare Cardiovascular Outcomes Registry; HF, Heart failure; ICD, Implantable cardioverter-defibrillator; ILR, Implantable loop recorder; MI, Myocardial infarction; NCDR, National Cardiovascular data registry; NOAC, Non-Vitamin K-dependent Oral Anticoagulant; OR, Odds ratio; Outcomes; PCI, Percutaneous coronary intervention; PM, Pacemaker; Quality; Registry; Sex; VDD, Ventricular sensing dual chamber pacing; VT/VF, Ventricular tachycardia/fibrillation; VVI, Ventricular sensing and pacing.