Heart failure & cardiomyopathies
Differences in mode of death between men and women receiving implantable cardioverter-defibrillators or cardiac resynchronization therapy in the MADIT trials
Authors' conclusion
Mode of death differs between sex and is dependent on the underlying cardiac substrate. Compared to women, cardiac death is higher in men with ICM but similar in those with NICM. ICDs are equally effective at reducing mortality in both men and women. However, CRT-D may be more effective at reducing mortality in women.
Study context
- Population
- Patients with ischemic cardiomyopathy (ICM) or nonischemic cardiomyopathy (NICM), LVEF ≤30%, NYHA class I–III HF, receiving implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D)
- Participants
- 3,038 vs 1,000
- Comparison
- Men vs women receiving ICD or CRT-D
- Menn = 3,038
- Womenn = 1,000reference
- Primary endpoint
- Mode of death (cardiac vs noncardiac) and device efficacy by sex
- Follow-up
- 26 months
Methodological detailsMADIT-II, MADIT-CRT, MADIT-RIT, adjudicated mode of death, Mode of death reviewed by independent adjudication committees
- MADIT-II, MADIT-CRT, MADIT-RIT
- Adjudicated mode of death
- Mode of death reviewed by independent adjudication committees
Primary result
As reported in the abstract
All-cause death
| Group | Value | Most common cause: nonarrhythmic cardiac death | Most common cause: noncardiac death |
|---|---|---|---|
| Men | 9.7% | n = 121 [41%] | |
| Women | 6.6% | n = 22 [33%] |
Value
Men9.7%
Women6.6%
Most common cause: nonarrhythmic cardiac death
Menn = 121 [41%]
WomenNot reported in the abstract
Most common cause: noncardiac death
MenNot reported in the abstract
Womenn = 22 [33%]
- Men vs Women: P = 0.003
Further findings
All-cause and cardiac death by cardiomyopathy type (adjusted)
- 1.5- to 2.0-fold higher in men vs women with ICM
- Similar in men and women with NICM
- After adjustment for covariates
Device efficacy for all-cause mortality
- ICD efficacy similar in men and women; reduction in all-cause mortality
- 50%
- CRT-D more effective at reducing all-cause and cardiac death in women than men
Original publication
Differences in mode of death between men and women receiving implantable cardioverter-defibrillators or cardiac resynchronization therapy in the MADIT trials. Heart Rhythm. Published 22 August 2022. doi:10.
Summarised from the published abstract; every number is checked against it