Is there a sex bias in implantable cardioverter-defibrillator referral and prescription?

The trandolapril cardiac evaluation investigators reported a male to female ratio of sudden cardiac death in coronary disease of 1.4: 1. The low proportion of female subjects undergoing implantable cardioverter-defibrillator (ICD) implantation is well recognized and these data lead the authors to question whether there could be a sex bias in the referral or prescription of ICD in patients with coronary artery disease (CAD). The authors analysed the characteristics of 514 ICD implants performed between January 1990 and October 2002. Their study indicates that too few females with CAD are referred for an ICD.