Persistent sex disparities in implantable cardioverter‐defibrillator therapy

Johnson, Amber; Adhikari, Shubash; Althouse, Andrew D.; Thoma, Floyd; Marroquin, Oscar C.; Koscumb, Stephen; Hausmann, Leslie R.M.; Myaskovsky, Larissa; Saba, Samir

doi:10.1111/pace.13435

Cited by 14 publications

(15 citation statements)

References 48 publications

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“…These disparities are in concordance with previous studies which demonstrated race and sex disparities in ICD utilization rates. 31,32 Our study did demonstrate the lower likelihood of arrhythmias in women compared with men, however, the disparity in ICD therapy can be related to other patient-and provider-related factors which needs further studies to fully understand. Bold P values are significant (P <.05).…”

Section: Discussionmentioning

confidence: 65%

Trends, burden, and impact of arrhythmia on cardiac amyloid patients: A 16‐year nationwide study from 1999 to 2014

Isath

Correa²,

Siroky³

et al. 2020

Journal of Arrhythmia

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Background Patients with cardiac amyloidosis (CA) have increased mortality, which can be explained in part by an increased risk of arrhythmias. The burden of arrhythmias in CA, their predictors, and impact on in‐hospital outcomes remains unclear. The role of implantable cardioverter‐defibrillators (ICD) in this population is also uncertain. Methods We queried the National Inpatient Sample (NIS) using ICD‐9‐CM codes 277.39 and 425.7 to identify CA. Twelve common arrhythmias were extracted using appropriate, validated ICD‐9‐CM codes. ICD implantation was identified using procedure ICD‐9 codes 37.94 to 37.98, 00.51 and 00.54. Results There were a total of 145,920 CA hospitalizations between 1999 and 2014 in the United States and 56,199 (38.5%) of them were associated with arrhythmias. The prevalence of arrhythmias remained relatively constant from 41.5% in 1999 to 40.2% in 2014. The most common arrhythmia was atrial fibrillation (25.4%). In‐patient mortality was significantly higher in CA patients with arrhythmias (10.4% vs 6.5%, P < .001). ICD implantation was performed in 1,381 (0.94%) patients with CA and analysis revealed an incremental trend in implantation over the study period (0.48% in 1999 to 0.65% in 2014). In‐hospital mortality was significantly lower in patients who underwent ICD implantation (3.7% vs 8%; P = .0078). CA patients with arrhythmias also had an increased cost of hospitalization and length of stay ($65,046 ± 1,079 vs $53,322 ± 687 and 8.3 ± 0.1 vs 7.4 ± 0.1 days, respectively; P < .0001). Conclusion Cardiac arrhythmias are common in patients with CA and are associated with worse in‐hospital outcomes, increased length of stay, and cost of hospitalization.

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Section: Discussionmentioning

confidence: 65%

Trends, burden, and impact of arrhythmia on cardiac amyloid patients: A 16‐year nationwide study from 1999 to 2014

Isath

Correa²,

Siroky³

et al. 2020

Journal of Arrhythmia

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“…The predominance of men in the implanted population was found in other observational and registry studies. 27,28 The cause for this finding is most likely a higher cardiac disease prevalence in men, but this result raises the possibility that ICD therapy might be underutilized in women. Underutilization could be addressed by comparing gender…”

Section: Resultsmentioning

confidence: 99%

Trends in the use of implantable cardioverter‐defibrillators for prevention of sudden cardiac arrest: A South Korean nationwide population‐based study

Roh

Choi

Kim

et al. 2019

Pacing Clinical Electrophis

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Background The benefits of implantable cardioverter‐defibrillators (ICDs) for the prevention of sudden cardiac arrest (SCA) are well established. However, a significant knowledge gap remains regarding current indications and utilization of ICDs in real‐world settings in Asia. Methods Patients who underwent ICD implantation in South Korea from 2007 to 2015 were identified using the Health Insurance Review and Assessment Service database. We investigated trends in use of ICD for the prevention of SCA. Results A total of 4649 ICDs were implanted during 9 years. ICDs were implanted in 1448 (31.2%) patients for primary prevention and in 3201 (68.8%) for secondary prevention. The proportion of ICDs for primary prevention increased from 6.1% in 2007 to 41.9% in 2015. Primary prevention was more frequent in older (≥40 years) recipients (34.4% vs. 14.6%, P < .0001). The rates of ICD implantation for primary prevention were highest for nonischemic dilated cardiomyopathy (55.1%) and lowest (9.7%) for inherited primary arrhythmia syndrome (IPAS). Conclusion Our data showed a trend of progressively increasing rates of ICD implantation in Asia, especially for primary prevention of SCA. Primary prevention as an indication for ICD in patients with IPAS remained low.

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“…Despite the overwhelming evidence of the survival benefit of ICDs, several studies have highlighted disparities in ICD implantation among ICD-eligible women and black patients. 6,7,12,13 Cultural differences in preference, and poor communication with physicians, may partially explain these sex-and race-based ICD disparities. 6,7,14 In our study, only a minority of physicians were aware of sex-and race-based differences in patients' perceptions related to ICD implantation and, as a result, modified their SDM approach.…”

Section: Discussionmentioning

confidence: 99%

Physicians’ perceptions of shared decision‐making for implantable cardioverter‐defibrillators: Results of a physician survey

Ali‐Ahmed

Matlock

Zeitler

et al. 2019

Cardiovasc electrophysiol

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Background Centers for Medicare and Medicaid Services has mandated the use of shared decision‐making (SDM) for implantable cardioverter‐defibrillator (ICD) implantation. SDM tools help facilitate quality SDM by presenting patients with balanced evidence‐based facts related to risk and benefits. Perceptions of ICD implantation may differ based on patients’ sex and race. Objective To determine if and how physicians are incorporating SDM in counseling patients about ICD and if they are aware of sex‐ and race‐based differences in patients’ perception of ICDs. Methods This was a pilot study involving an online survey targeting attending physicians who implant ICDs. Physicians were randomly selected by a computer‐based program; 350 surveys were sent. Results Of the 124 (35%) respondents to the survey, 102 (84%) met the inclusion criteria, and of those, 99 (97%) were adult electrophysiologists. Most physicians (90, 88%) stated they engaged in SDM during the general consent process. Sixty‐three (62%) physicians discuss end of life issues while obtaining general consent. Forty‐four (43%) physicians said they use an existing SDM tool with the Colorado SDM tool being the most common (39, 89%). The majority of physicians were unaware of sex‐ and race‐based differences in perceptions related to ICD implantation (sex 64, 63% and race 63, 62%). Conclusion A vast majority of physicians are engaging in SDM; however less than half are using a formal SDM tool, and a minority of physicians were aware of sex‐ and race‐based differences in patients’ perception of ICD implantation. Sex‐ and race‐based tools might help address this gap.

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Persistent sex disparities in implantable cardioverter‐defibrillator therapy

Abstract: In this large, outpatient cohort, we have shown that sex differences in ICD therapy continue to exist, but the difference in ICD prevalence by race was attenuated. Dedicated studies are required to fully understand the causes of persistent sex differences in ICD therapy.

Cited by 14 publications

References 48 publications

Trends, burden, and impact of arrhythmia on cardiac amyloid patients: A 16‐year nationwide study from 1999 to 2014

Trends, burden, and impact of arrhythmia on cardiac amyloid patients: A 16‐year nationwide study from 1999 to 2014

Trends in the use of implantable cardioverter‐defibrillators for prevention of sudden cardiac arrest: A South Korean nationwide population‐based study

Physicians’ perceptions of shared decision‐making for implantable cardioverter‐defibrillators: Results of a physician survey

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