Clinical research studyDisparities in the Use of Primary Prevention and Defibrillator Therapy Among Blacks and Women
Section snippets
Study Design and Patient Identification
The Provider Analysis and Review files from the Center for Medicare and Medicaid Services database of hospital admissions in the United States during the year 2002 were used to compare the clinical characteristics of all patients who were potential candidates for implantable cardioverter-defibrillator therapy for primary prevention with those of patients who actually underwent implantable cardioverter-defibrillator implantation.
In the year 2002, implantable cardioverter-defibrillator therapy
Results
Among all Medicare patients who were admitted to a hospital in the United States during the year 2002, 132 565 patients were identified as having an ischemic cardiomyopathy. The clinical characteristics of the patients are summarized in Table 1. Eighty-eight percent of patients were categorized as white, 8.0% as black, 0.5% as Asian, 1.5% as Hispanic, 0.4% as North American Native, and 1.2% as other.
Among these potential implantable cardioverter-defibrillator candidates, 10 370 (8%) underwent
Main Findings
This is the first study that has attempted to identify racial and gender discrepancies in the use of implantable cardioverter-defibrillator therapy for primary prevention. Potential candidates were identified using hospital admission diagnostic codes that reflected the presence of an ischemic cardiomyopathy. The main findings of this study are that women and black patients are significantly underrepresented among Medicare patients with an ischemic cardiomyopathy who receive implantable
Limitations
The indications for defibrillator therapy for primary prevention of sudden death are largely based on the left ventricular ejection fraction. However, the Center for Medicare and Medicaid Services database does not contain information regarding left ventricular function. Therefore, the presence of coronary artery disease and heart failure was used as a surrogate for left ventricular dysfunction. However, it is possible that the use of diagnostic codes to identify patients with an ischemic
Conclusions
Use of implantable cardioverter-defibrillator therapy for primary prevention of sudden death among the elderly population identified as having an ischemic cardiomyopathy was significantly lower among women compared with men and was lower among blacks compared with whites. Further exploration of gender and racial barriers to appropriate implantable cardioverter-defibrillator use for primary prevention is needed.
References (22)
- et al.
ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices-summary article
J Am Coll Cardiol
(2002) - et al.
Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes
J Am Coll Cardiol
(2005) - et al.
Influences of patient characteristics in the selection of patients for defibrillator implantation (the AVID registry)
Am J Cardiol
(1997) - et al.
Management of ventricular arrhythmias in diverse populations in California
Am Heart J
(2002) - et al.
Utilization of implantable cardioverter-defibrillators in survivors of cardiac arrest in the United States from 1996-2001
J Am Coll Cardiol
(2004) - et al.
Trends in implantable cardioverter-defibrillator racial disparity
J Am Coll Cardiol
(2005) - (2000)
State-specific mortality from sudden cardiac deathUnited States, 1999
MMWR Morb Mortal Wkly Rep
(2002)- et al.
A randomized study of the prevention of sudden cardiac death in patients with coronary artery disease
N Engl J Med
(1999) - et al.
Improved survival with an implantable defibrillator in patients with coronary disease at high risk for ventricular arrhythmia
N Engl J Med
(1996)
Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction
N Engl J Med
Cited by (65)
Disparities in Referral and Utilization of Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death
2023, Canadian Journal of CardiologyRacial and ethnic differences in implantable cardioverter-defibrillator patient selection, management, and outcomes
2022, Heart Rhythm O2Citation Excerpt :While some regional variation exists, it is estimated that only 20%–40% of all eligible patients ultimately have an ICD implanted,7,25,28 and this varies widely by race (Figure 1). Black patients and those belonging to other racial and ethnic subgroups are significantly less likely to receive a primary prevention ICD compared with White patients, even when accounting for relevant clinical and nonclinical factors (eg, location, insurance, clinical status).8,26–28 For example, an analysis of the National Registry to Advance Heart Health found that among eligible patients, Black patients were significantly less likely than White patients to receive an ICD (30% vs 40%, P < .001), and this difference persisted even when controlling for demographics, clinical characteristics, and socioeconomic differences (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.5–0.75, P < .001).8
Implantable cardioverter-defibrillator placement among patients with left ventricular ejection fraction ≤35 % at least 40 days after acute myocardial infarction
2022, American Heart Journal Plus: Cardiology Research and PracticeRacial and Sex Disparities in the Management of Hypertrophic Cardiomyopathy
2022, Mayo Clinic ProceedingsImplantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy in Women
2019, Heart Failure ClinicsCitation Excerpt :Although the use of ICDs has been shown to improve mortality, women are significantly less likely than men to receive this therapy for both primary and secondary prevention of SCD.27,32 In a study comprising more than 132,000 patients with ischemic cardiomyopathy who were potential candidates for ICD therapy, men were more likely to receive an ICD than women.33 In another large Medicare study comprising both patients in a primary and secondary prevention cohort, men were more likely to receive ICDs in both groups.32
This study was supported by an unrestricted grant from Guidant Inc., St. Paul, Minn.