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BMJ. 2007 October 13; 335(7623): 744.
PMCID: PMC2018802
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Implantable cardioverter defibrillators given more often to men

Two recent studies showing that women are less likely than men to get an implantable cardioverter defibrillator may be bad news for women, says a linked editorial (p 1564). Alternatively, the findings may be bad news for men, as it is far from clear that these devices improve quality of life or survival in real patients who are older and sicker than the participants of randomised trials.

In one cohort of Medicare beneficiaries (aged over 65) with heart failure or cardiomyopathy, men were two to three times more likely to be treated with an implantable cardioverter defibrillator than women. But treatment made no difference to their risk of death (hazard ratio 1.01, 95% CI 0.82 to 1.23). These results are troubling, says the editorial, and hard to explain. The authors adjusted their analysis for age, comorbidity, and the probability of treatment.

A second cohort study included patients admitted to hospitals participating in a quality improvement programme. Only a third of eligible patients had an implantable defibrillator by the time they went home. Women missed out, and so did men and women from ethnic minorities.

Health inequalities for women and other groups are not new, says the editorial. But in this case, the usual hunt for root causes should be accompanied by a critical re-evaluation of the role of implantable cardioverter defibrillators in real world practice.


  • JAMA 2007;298:1517-24 [PubMed]
  • JAMA 2007;298:1525-32 [PubMed]

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