Sex and Gender in Cardiac Resynchronization Therapy Cohort Studies: A Systematic Methodological Review and Meta-Analysis of Cohort Studies

Abstract

Randomized trials and cohort studies have shown sex differences in the implantation and response to Cardiac Resynchronization Therapy (CRT). Furthermore, gender roles are associated with precipitants of congestive heart failure. Cohort studies are well-suited to assessing implantation rates, long-term outcomes, and the role of sex and gender. Therefore, we systematically identified cohort studies that reported outcomes of CRT and evaluated the following: 1) prevalence and temporal changes in sex and gender reporting and analysis; and 2) sex differences in the implantation and response to CRT. Sex was increasingly considered but remained inadequately reported and analyzed. Gender was not considered in the studies. In clinical practice, fewer women received devices, despite benefiting from CRT more than men. Of note, the difference in response may be confounded by differences in the clinical profiles of men and women. There is a need for better integration of sex and gender in studies to understand better the reasons leading to the observed differences.