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

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\u202fyear were analysed. Results The mean age was 76.2\u202f+\u202f11.2\u202fyears, and 2022 (37.7%) were female. Women were older than men at device implantation (77.0\u202f±\u202f11.6\u202fyears vs. 75.5\u202f±\u202f10.9\u202fyears, p\u202f<\u202f0.001). 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\u202f<\u202f0.001) and less often for A-V block (28.3% vs. 35.1%, p\u202f<\u202f0.001). Adverse events at 30\u202fdays 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\u202f=\u202f0.49) or major complications (HR 1.41, 95% 95% CI 0.65–3.03, p\u202f=\u202f0.39). 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\u202f=\u202f0.77) 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.