Gender Disparity of Automatic Implantable Cardioverter Defibrillator Placement for Primary Prevention: National Inpatient Sample Analysis.

Introduction Automatic Implantable Cardioverter-Defibrillators (AICD) for the primary prevention of sudden cardiac death (SCD) have become standard care for patients with systolic heart failure (sHF) and ejection fraction < 35%. While the prevalence of sHF and rates of hospitalization are higher in men; one would expect equivalent rates of implantation in women. Methods We used the Healthcare Cost and Utilization Project's National Inpatient Sample (NIS) from 2009-2018 to identify patient visits with sHF and AICD implantation. The co-morbidities and outcomes were compared based on gender. Results There were 15,247,854 inpatient admissions for sHF, of which 60.3% males, (95% CI 60.1%-60.4%) and 39.8% females (95% CI 39.7%-39.9%). Approximately 2% of patients (294,726) underwent the insertion of an AICD for primary prevention; 72.3% males (95% CI 71.9%-72.7%) and 27.72% females (95% CI 27.3%-28.1%). There was no significant difference in age (p=0.29), length of Stay (LOS) (p=0.09) and inpatient mortality (p=0.18). Conclusion In this study, women accounted for approximately 40% of patients admitted with the diagnosis of sHF, however, they accounted for less than 30% of patients who underwent the insertion of an AICD. Further research is needed to better understand this gender disparity and identify reasons for the lower rates of AICD placement in women.