RESUMO
BACKGROUND: Although several studies have shown the effectiveness of cardiac resynchronization therapy (CRT) for advanced congestive heart failure (CHF), gender differences in utilization of CRT are not known. METHODS: We used the Healthcare Cost and Utilization Project (HCUP) to study national rates for admissions due to CHF along with procedures for initial CRT implantation, including both CRT-defibrillator (CRT-D) and CRT-pacemakers (CRT-P) during the years of 2002-2004. Chi-square tests were used for comparison between number of women and men. A P < 0.05 was considered significant. RESULT: Women had consistently higher rates of admission for CHF during each year (574,037 (54%) vs 482,005 (46%), 2002; 601,181 (54%) vs 517,202 (46%), 2003; and 580,913 (53%) vs 521,280 (47%), 2004). The number of initial CRT device implantations (both CRT-D and CRT-P) was significantly lower during each year for women compared to men (659 (25%) vs 1,931 (75%), 2002; 6,928 (26%) vs 19,646 (74%), 2003; and 11,286 (27%) vs 42,196 (73%), 2004; P < 0.01 for all). Both CRT-P and CRT-D were used less frequently in women compared to men; however, this difference was consistently less prominent during each year with CRT-P compared to CRT-D (301 (41%) CRT-P vs 358 (19%) CRT-D, 2002; 659 (39%) CRT-P vs 2,530 (28%) CRT-D, 2003; and 2,891 (39%) CRT-P vs 8,395 (24%) CRT-D, 2004; P < 0.05). CONCLUSION: Our data clearly demonstrate a significant gender disparity in utilization of CRT devices. Further studies are needed to find possible reasons behind this disparity.
Assuntos
Estimulação Cardíaca Artificial/estatística & dados numéricos , Cardioversão Elétrica/estatística & dados numéricos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/prevenção & controle , Admissão do Paciente/estatística & dados numéricos , Alocação de Recursos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Estados Unidos/epidemiologiaRESUMO
Pulmonary hypertension is a daunting accompaniment of advanced heart failure. Efforts to safely and consistently lower pulmonary vascular resistance are necessary but fraught with challenges. In this report the authors explore the novel use of sildenafil, an inhibitor of phosphodiesterase-5, in tackling pulmonary hypertension in heart failure. The salutary effects of this agent deserve further study.