Differences in clinical characteristics and reported quality of life of men and women undergoing cardiac resynchronization therapy

Bruce L Wilkoff, David Birnie, Michael R Gold, Ahmad S Hersi, Sandra Jacobs, Bart Gerritse, Kengo Kusano, Christophe Leclercq, Wilfried Mullens, Gerasimos Filippatos, Bruce L Wilkoff, David Birnie, Michael R Gold, Ahmad S Hersi, Sandra Jacobs, Bart Gerritse, Kengo Kusano, Christophe Leclercq, Wilfried Mullens, Gerasimos Filippatos

Abstract

Aims: Response to cardiac resynchronization therapy (CRT) is known to be associated with a number of clinical characteristics, including QRS duration and morphology, gender, height, and the aetiology of heart failure (HF). We assessed the relation of gender and baseline characteristics with QRS duration and Kansas City Cardiomyopathy Questionnaire.

Methods and results: AdaptResponse is a global randomized trial. The trial enrolled CRT-indicated patients with New York Heart Association classes II-IV HF, left bundle branch block (QRS ≥ 140 ms in men, ≥130 ms in women), and baseline PR interval ≤200 ms. In total, 3620 patients were randomized, including 1569 women (43.3%) approaching the actual proportion of women in the HF population. Women were older and more often New York Heart Association class III or IV than men (55.6% vs. 48.7%), had less frequent ischaemic cardiomyopathy (21.2% vs. 39.5%), and had a 5.1 ms shorter QRS duration than men. Women were more often depressed (18.5% vs. 9.7%), had a significantly lower Kansas City Cardiomyopathy Questionnaire score, and had differences in medication prescriptions.

Conclusions: AdaptResponse is the largest randomized CRT trial and enrolled more women than any other landmark CRT trial. Women differed from men with regard to baseline characteristics and quality of life. Whether these differences translate into clinical outcome differences will be examined further in the AdaptResponse trial.

Trial registration: ClinicalTrials.gov NCT02205359.

Keywords: AV conduction; Cardiac resynchronization therapy outcome; Gender differences in heart failure; Kansas City Cardiomyopathy Questionnaire; LV pacing; Left bundle branch block.

Conflict of interest statement

B.L.W. participated in Physician Advisory Committees of Medtronic, Abbott, Philips and reports honoraria from Medtronic, Abbott, Philips. D.B. is a mid‐career investigator supported by the Heart and Stroke Foundation of Ontario and by the University of Ottawa Chair in Electrophysiology Research. He has received major research funding from Medtronic, Boston Scientific, Boehringer Ingelheim, Bayer, Biotronik, Pfizer, and Bristol Myers Squibb. M.R.G. is a consultant to Medtronic and Boston Scientific and receives honoraria from Medtronic, Boston Scientific, and EBR. A.S.H., K.K., and W.M. have no conflicts of interest to disclose. S.J. and B.G. are employed by Medtronic. C.L. participated in a Medtronic advisory board and reports honoraria received from Medtronic, Biotronik, LivaNova, Boston Scientific, and Abbott. G.F. participated in committees of trials sponsored by Bayer, Novartis, Servier, Vifor, BI, and Medtronic.

© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Figures

FIGURE 1
FIGURE 1
Kansas City Cardiomyopathy Questionnaire (KCCQ). Women had a significantly lower score on all KCCQ domains except self‐efficacy (P = 0.17). Bars represent the average score by gender for the different KCCQ domains, with associated 95% confidence interval. Annotations are P values from Student's t‐test.
FIGURE 2
FIGURE 2
The EQ‐5D score. (A) The five descriptive questions of the EQ‐5D‐3L Questionnaire for dimensions mobility, self‐care, usual activities, pain/discomfort, and anxiety/depression. These were reported with three answer categories indicating no, some, or extreme problems. The bars indicate the percentage of patients reporting any problems, including the latter two answer categories. The annotated P values are from Fisher's exact tests and compare by sex. (B) Summary of self‐rated health collected on a visual analog scale (range 0–100). The bars show the mean health score annotated with 95% confidence interval for the mean and a P value from Student's t‐test comparing sexes.
FIGURE 3
FIGURE 3
Relation of QRS duration with height and gender. Solid curves represent the smoothed average QRS duration for height and gender (penalized B‐splines). Vertical dashed lines represent average height for women and men.

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Source: PubMed

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