ICDs in women with heart failure? Won’t work, suggests meta-analysis

The heart.org
SEPTEMBER 14, 2009 | Steve Stiles
Southfield, MI – Women don’t share in the survival benefits of implantable cardioverter defibrillator (ICD) therapy that have been demonstrated in men in the setting of systolic heart failure, according to a meta-analysis of five major randomized trials. These were the same five trials that were instrumental in bringing the device therapy from the realm of secondary protection against sudden death to broad-based use for primary prevention in both men and women [1].

The study, which appears in the September 14, 2009 Archives of Internal Medicine, highlights the huge gap in what is known about the effectiveness of cardiovascular therapies between men and women. Women are by far the minority in most randomized trials, although outcomes are often assumed to apply to women.

Until there are adequately powered randomized trials looking at ICD effectiveness in women with heart failure, there’s this meta-analysis, note the authors, led by Dr Hamid Ghanbari (Providence Hospital Heart Institute and Medical Center, Southfield, MI). It suggests that the assumptions equating male and female treatment responses may be wrong, at least in the case of ICD therapy.

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CLINICAL CARDIOLOGY Ivabradine BEAUTIFUL in subset of patients with angina and heart rates >70 bpm

Ivabridine may be helpful in reducing major cardiovascular events in patients with stable CAD and LV dysfunction who present with limiting angina, especially if they have a heart rate of 70 beats per minute or more, a post hoc analysis from the Morbidity-Mortality Evaluation of the I_f Inhibitor Ivabradine in Patients With Coronary Artery Disease and Left Ventricular Dysfunction (BEAUTIFUL) trial suggests. The findings were met with some skepticism when presented at the European Society of Cardiology (ESC) 2009 Congresslast week; however, senior author Dr Roberto Ferrari (University of Ferrara, Italy), who presented the subgroup analysis at a clinical-trials-update session, noted that a large-scale clinical trial is ongoing, which will formally test this hypothesis.