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Background: Patients with chronic right ventricular (RV) pacing are at an increased risk of heart failure. Previous studies have indicated that cardiac resynchronization therapy (CRT) is underused in this setting, and that there may be sex‐based differences in both CRT use and clinical outcome. Objective: To evaluate sex‐based differences in CRT use and clinical outcome for patients with new‐onset heart failure post RV pacing. Methods: Data from the Swedish pacemaker registry was matched with data from the national death and disease registries. Patients with de novo pacemaker implant due to AV block during the period 2005–2020 were included. New‐onset heart‐failure within two years post‐implant was evaluated, primary outcome was all‐cause mortality. Results: In all, 30183 patients (37% female) were included. Women were on average 3 years older, but had less comorbidities than men. Median follow‐up time was 4.5 [2.0–8.0] years. Women had better age‐ and comorbidity‐adjusted survival (HR 0.78 [0.73–0.84], p <.001). For the 3560 patients (12.4% men and 10.7% women, p <.001) who were diagnosed with new‐onset heart failure, 5‐year mortality was similar for men and women (50% vs. 48%, p =.29). However, women were less likely to receive CRT‐upgrade (3.8% vs. 9.1%, p <.001), and those who did were almost ten years younger than the men. Conclusion: Women with pacemaker due to AV block are older but have less comorbidities than men. They are less likely to develop new‐onset heart failure, but also less likely to receive a CRT upgrade if they do develop heart failure. Increased awareness of the positive effects of CRT upgrade and potential sex‐ and age‐based discrimination is warranted. [ABSTRACT FROM AUTHOR]

Aims: Cardiac resynchronization therapy (CRT) has a well-documented positive effect on mortality and heart failure morbidity. The aim of this study was to assess the long-term survival and the predictive value of self-assessed functional status on the long-term prognosis of patients treated with CRT-pacemaker (CRT-P)., Methods and Results: Data were retrospectively collected from medical records of 446 consecutive patients implanted with CRT-P at a large-volume Swedish tertiary care centre. Primary outcome was all-cause mortality, predictive variables were assessed by log-rank test and univariate cox regression. Three hundred and nine patients had reliable information available on early improvement after implantation and were included in the multivariate analyses. The cohort was followed for a median of 79 months and was similar in baseline characteristics compared with major controlled trials. During follow-up 204 patients died, yearly mortality was 11.7%. Early improvement of self-assessed functional status was a strong independent predictor of survival [hazard ratio, HR 0.59, confidence interval (CI) 0.40-0.87, P = 0.007], together with well-known predictors; NYHA III-IV vs I-II (HR 1.66, CI 1.09-2.536, P = 0.018), age (HR 1.05, CI 1.03-1.08, P < 0.001), male gender (HR 2.0, CI 1.11-3.45, P = 0.021), and loop diuretic use (HR 4.41, CI 1.08-18.02). Patients with early improvement of self-assessed functional status had better 2-year and 5-year survival (P < 0.001)., Conclusions: Real-life patient characteristics and predictors of outcome compare well with those in published prospective trials. Self-assessed functional status is a strong predictor of long-term survival, which may have implications for a more active follow-up of patients without spontaneous improvement., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.)