Women have better long-term prognosis than men after cardiac resynchronization therapy

Cardiac resynchronization therapy (CRT) improves prognosis in patients with moderate-to-severe heart failure, reduced left ventricular ejection fraction, and wide QRS complexes. However, CRT may be under-utilized in women and data on long-term follow-up are still scarce. The aim was to investigate long-term mortality and hospitalization and prognostic impact of gender after CRT. Data on 619 consecutive patients (19 women) that received CRT at a single centre between 1998 and 2008 were collected from electronic medical records and national death and hospitalization registries up to 2010. The primary endpoint was death of any cause and the secondary endpoint was combined death of any cause or heart failure hospitalization. Over a mean follow-up of 1320 786 days, 215 (35) patients reached the primary endpoint and 437 (71) the secondary endpoint. Overall, 1-, 5-, and 10-year survivals were 91, 63, and 39, respectively. Female gender was the only independent predictor of all-cause mortality; hazard ratio (HR) 0.44 [95 confidence interval (CI), 0.210.90; P 0.025]. Women also had a trend towards lower risk for the secondary endpoint, HR 0.68 (95 CI, 0.451.04; P 0.072). In this registry analysis, patients with CRT had similarly high short-term survival to those in controlled trials, and this favourable prognosis was sustained over the long term.Women had lower all-cause mortality than men.