example of sex differences in cvd of clinical importance - crt€¦ · mounting evidence for...
TRANSCRIPT
![Page 1: Example of Sex Differences in CVD of Clinical Importance - CRT€¦ · Mounting Evidence for Sex-Differences In CRT Cross-sectional data from the National Inpatient Sample database](https://reader035.vdocuments.mx/reader035/viewer/2022062606/5fdecf49c5862368b70a06e7/html5/thumbnails/1.jpg)
Example of Sex Differences in CVD
of Clinical Importance - CRT
Viviany R. Taqueti, MD, MPH, FACC Associate Physician, Noninvasive Cardiovascular Imaging Program
Brigham and Women’s Hospital, Boston, MA Assistant Professor, Harvard Medical School
Controversies & Advances in the Treatment of CVD
Beverly Hills, CA
November 17, 2017
HARVARD MEDICAL SCHOOL TEACHING AFFILIATE Heart & Vascular Center
![Page 2: Example of Sex Differences in CVD of Clinical Importance - CRT€¦ · Mounting Evidence for Sex-Differences In CRT Cross-sectional data from the National Inpatient Sample database](https://reader035.vdocuments.mx/reader035/viewer/2022062606/5fdecf49c5862368b70a06e7/html5/thumbnails/2.jpg)
Disclosures
None
![Page 3: Example of Sex Differences in CVD of Clinical Importance - CRT€¦ · Mounting Evidence for Sex-Differences In CRT Cross-sectional data from the National Inpatient Sample database](https://reader035.vdocuments.mx/reader035/viewer/2022062606/5fdecf49c5862368b70a06e7/html5/thumbnails/3.jpg)
Growing Scrutiny for Evidence-Based Use of
Cardiac Procedures and Devices
![Page 4: Example of Sex Differences in CVD of Clinical Importance - CRT€¦ · Mounting Evidence for Sex-Differences In CRT Cross-sectional data from the National Inpatient Sample database](https://reader035.vdocuments.mx/reader035/viewer/2022062606/5fdecf49c5862368b70a06e7/html5/thumbnails/4.jpg)
Understanding of Sex Differences Requires
Sound Scientific Methodology
We will not find them if we do not look..
Shaw LJ and Bairey Merz CN (2017) JACC 70:373–88
![Page 5: Example of Sex Differences in CVD of Clinical Importance - CRT€¦ · Mounting Evidence for Sex-Differences In CRT Cross-sectional data from the National Inpatient Sample database](https://reader035.vdocuments.mx/reader035/viewer/2022062606/5fdecf49c5862368b70a06e7/html5/thumbnails/5.jpg)
An Example of Emerging Clinical Importance:
Cardiac Resynchronization Therapy (CRT)
Biventricular pacing
![Page 6: Example of Sex Differences in CVD of Clinical Importance - CRT€¦ · Mounting Evidence for Sex-Differences In CRT Cross-sectional data from the National Inpatient Sample database](https://reader035.vdocuments.mx/reader035/viewer/2022062606/5fdecf49c5862368b70a06e7/html5/thumbnails/6.jpg)
De
ath
or
HF
Ho
sp
ita
lizati
on
An Example of Emerging Clinical Importance:
Cardiac Resynchronization Therapy (CRT)
Mortality (+/- ICD)
Morbidity In patients with heart failure and
LVEF <35% with QRS >120 ms
Abraham WT et al (2002) NEJM; 346:1845-53 Bristow MR et al (2004) NEJM; 350:2140-50 Cleland JG et al (2006) Eur Heart J;27:1928–1932
![Page 7: Example of Sex Differences in CVD of Clinical Importance - CRT€¦ · Mounting Evidence for Sex-Differences In CRT Cross-sectional data from the National Inpatient Sample database](https://reader035.vdocuments.mx/reader035/viewer/2022062606/5fdecf49c5862368b70a06e7/html5/thumbnails/7.jpg)
An Example of Emerging Clinical Importance:
Cardiac Resynchronization Therapy (CRT)
Mortality
Morbidity
LV Volume
LV EF
Hsu JC et al (2012) JACC; 59:2366-73 Richardson M et al (2007) EHJ; 1827 Rickard J et al (2010) Hrt Rhthm; 885
![Page 8: Example of Sex Differences in CVD of Clinical Importance - CRT€¦ · Mounting Evidence for Sex-Differences In CRT Cross-sectional data from the National Inpatient Sample database](https://reader035.vdocuments.mx/reader035/viewer/2022062606/5fdecf49c5862368b70a06e7/html5/thumbnails/8.jpg)
Challenge: Women Under-Represented in Trials
Abraham WT et al (2002) NEJM; Bristow MR et al (2004) NEJM; Hsu JC et al (2012) JACC
![Page 9: Example of Sex Differences in CVD of Clinical Importance - CRT€¦ · Mounting Evidence for Sex-Differences In CRT Cross-sectional data from the National Inpatient Sample database](https://reader035.vdocuments.mx/reader035/viewer/2022062606/5fdecf49c5862368b70a06e7/html5/thumbnails/9.jpg)
Mounting Evidence for Sex-Differences In CRT
Cross-sectional data from the National Inpatient Sample database of
311,009 pts undergoing CRT implantation in the US from 2006-2012
Stratify patients by baseline predictors of those:
(1) Most likely to demonstrate/benefit from CRT response
(2) Less likely to demonstrate reduced ICD efficacy
Chatterjee NA et al (2017) EHJ; 38:1485-1494 Taqueti VR and Bairey Merz CN (2017) EHJ; 38:1495-7
![Page 10: Example of Sex Differences in CVD of Clinical Importance - CRT€¦ · Mounting Evidence for Sex-Differences In CRT Cross-sectional data from the National Inpatient Sample database](https://reader035.vdocuments.mx/reader035/viewer/2022062606/5fdecf49c5862368b70a06e7/html5/thumbnails/10.jpg)
Trends in Sex Differences in CRT-D Use
Chatterjee NA et al (2017) EHJ; 38:1485-1494; Taqueti VR and Bairey Merz CN (2017) EHJ; 38:1495-7
![Page 11: Example of Sex Differences in CVD of Clinical Importance - CRT€¦ · Mounting Evidence for Sex-Differences In CRT Cross-sectional data from the National Inpatient Sample database](https://reader035.vdocuments.mx/reader035/viewer/2022062606/5fdecf49c5862368b70a06e7/html5/thumbnails/11.jpg)
“Precision Medicine” Starts with Sex
![Page 12: Example of Sex Differences in CVD of Clinical Importance - CRT€¦ · Mounting Evidence for Sex-Differences In CRT Cross-sectional data from the National Inpatient Sample database](https://reader035.vdocuments.mx/reader035/viewer/2022062606/5fdecf49c5862368b70a06e7/html5/thumbnails/12.jpg)
Critical Components to Achieving Equity in
Quality of Care for Women (and Men)
Shaw LJ and Bairey Merz CN (2017) JACC 70:373–88
![Page 13: Example of Sex Differences in CVD of Clinical Importance - CRT€¦ · Mounting Evidence for Sex-Differences In CRT Cross-sectional data from the National Inpatient Sample database](https://reader035.vdocuments.mx/reader035/viewer/2022062606/5fdecf49c5862368b70a06e7/html5/thumbnails/13.jpg)
Changing Practice: More Data + Guidelines