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Implantable Defibrillators May Not Help Women With Heart Failure
Date:9/14/2009

"We need to find a way to study more women in order to be able to identify what subgroups truly benefit from this therapy," Machado said.

But that could be difficult. Given that current guidelines recommend the use of ICDs, it would be unethical to propose a trial that randomized some women to go without one, Machado explained.

And this data is certainly not likely to change cardiac care procedures. "I don't think this is going to change anyone's practice," said Dr. Seth Keller, associate director of cardiac electrophysiology at Lenox Hill Hospital in New York City. "Practice guidelines are pretty well-established in terms of ICDs. But this does raise a lot of questions."

"If it is true that women don't benefit from primary prevention with ICDs, then why not?" he added.

Machado speculated that reasons for women deriving different or less benefit from ICDs could range from different anatomy to hormonal factors to how women's bodies use calcium.

"I'm sure there's more than one factor leading to such a less dramatic benefit in women from this therapy," he said.

In fact, the devices might even cause harm. The editorial referenced one analysis that found that women have a 70 percent greater risk of problems after receiving an ICD than men.

"Let's question the dogma," Machado said. "Let's figure out how to change our recommendations."

But one expert urged caution.

Dr. Wojciech Zareba, director of the Heart Research Follow-Up Program at the University of Rochester Medical Center, felt that this meta-analysis, along with most papers in this form, was fraught with methodological problems that weakened the validity of the findings.

"I believe that we don't have evidence at this moment which would preclude using ICDs in women," Zareba said. "This is unfortunately only stirring the water and doesn't provide any useful clues."

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