Racial and ethnic differences in implantable cardioverter-defibrillator patient selection, management, and outcomes

Kiernan, Katherine; Dodge, Shayne E.; Kwaku, Kevin F.; Jackson, Larry R.; Zeitler, Emily P.

doi:10.1016/j.hroo.2022.09.003

Cited by 5 publications

(5 citation statements)

References 74 publications

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“…9 Similar findings have been found for other cardiovascular procedures including mitral valve replacement, and implantation of implantable cardioverter-defibrillators. 6,8,9 There is a pressing need to increase enrollment of minority patients into clinical trials either by way of mandated enrollment targets, broadening the clinical trial sites to include hospitals serving predominantly racial and ethnic minoritized patients and including investigators who also serve this patient population in clinical trials.…”

Section: Discussionmentioning

confidence: 99%

“…5 Racial and ethnic minority individuals have also been consistently shown to be undertreated in terms of other cardiovascular procedures like transcatheter aortic valve replacement (TAVR), mitral valve replacement, and implantation of implantable cardioverter-defibrillators. [6][7][8][9] In published clinical trials and real-world experience with transcatheter LAAO, non-Hispanic White patients have represented over 90% of cases; it is not clear that the efficacy in the overall population is generalizable to all racial and ethnic groups. Studies of racial and ethnic disparities in transcatheter LAAO outcomes have shown higher rates of in-hospital complications among non-Hispanic Black and Hispanic patients compared to non-Hispanic White patients.…”

Section: Introductionmentioning

confidence: 99%

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Racial and Ethnic Disparities in the Utilization and Outcomes with WATCHMAN FLX: A SURPASS analysis of the NCDR LAAO Registry

Alli,

Garg,

Boursiquot

et al. 2024

Preprint

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Background: Left atrial appendage occlusion (LAAO) is increasingly used as an alternative to oral anticoagulation for stroke prevention in select patients with atrial fibrillation. Data on outcomes in racial and ethnic minority individuals are limited. This analysis assessed differences in the utilization and outcomes of LAAO by race and ethnicity in a large national registry. Methods: This analysis acquired data on WATCHMAN FLX patients from the National Cardiovascular Data Registry (NCDR) LAAO Registry through September 2022. All patients with an attempted WATCHMAN FLX implantation and known race and ethnicity were included. Baseline characteristics and 1 year event rates were compared. Results: A total of 97,185 patients were analyzed; 87,339 were White (90%), 3,750 Black (Black/African American 3.9%), and 2,866 Hispanic ([Hispanic/Latinx] 2.9%). Black and Hispanic patients were younger with a higher incidence of prior stroke and significant bleeding compared to White patients. Black and Hispanic patients were treated with LAAO in smaller numbers relative to their proportion of the US population. Rates of procedural success were similar between groups. Though direct oral anticoagulants were prescribed in most patients across the groups, dual and single antiplatelet therapy were prescribed more often in Black patients. Black patients had significantly higher rates of 1-year death and bleeding compared to White and Hispanic patients. Conclusions: Patients from racial and ethnic minority groups comprise a disproportionately small fraction of all patients who undergo LAAO. Black and Hispanic patients were younger but had significantly higher comorbidities compared to White patients. Procedural success was similar amongst the groups but Black patients experienced higher rates of death and bleeding at 1 year.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Racial and Ethnic Disparities in the Utilization and Outcomes with WATCHMAN FLX: A SURPASS analysis of the NCDR LAAO Registry

Alli,

Garg,

Boursiquot

et al. 2024

Preprint

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“…A review by Kiernan et al highlighted the disproportionate effect of SCD disease burden in non-Caucasian identifying populations and racial and ethnic differences in the efficacy of implantable cardioverter-defibrillators in these groups. 23 In a retrospective postmortem study on sudden explained deaths, Lin et al utilized high-resolution variant classification in cardiac arrhythmogenic gene testing within a diverse cohort. 24 The study found that 3.1% of the Hispanic subjects tested positive for pathogenic or likely pathogenic arrhythmogenic genetic variants.…”

Section: Genetic Studies In Hispanic/ Latino Populationsmentioning

confidence: 99%

“… 22 These associations held true even after adjusting for age, sex, and other clinical variables. A review by Kiernan et al highlighted the disproportionate effect of SCD disease burden in non‐Caucasian identifying populations and racial and ethnic differences in the efficacy of implantable cardioverter‐defibrillators in these groups 23 . In a retrospective postmortem study on sudden explained deaths, Lin et al utilized high‐resolution variant classification in cardiac arrhythmogenic gene testing within a diverse cohort 24 .…”

Section: Genetic Studies In Hispanic/latino Populationsmentioning

confidence: 99%

Arrhythmias and ion channelopathies causing sudden cardiac death in Hispanic/Latino and Indigenous populations

Zaveri,

Chahine,

Boutjdir

2024

Cardiovasc electrophysiol

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The limited literature and increasing interest in studies on cardiac electrophysiology, explicitly focusing on cardiac ion channelopathies and sudden cardiac death in diverse populations, has prompted a comprehensive examination of existing research. Our review specifically targets Hispanic/Latino and Indigenous populations, which are often underrepresented in healthcare studies. This review encompasses investigations into genetic variants, epidemiology, etiologies, and clinical risk factors associated with arrhythmias in these demographic groups. The review explores the Hispanic paradox, a phenomenon linking healthcare outcomes to socioeconomic factors within Hispanic communities in the United States. Furthermore, it discusses studies exemplifying this observation in the context of arrhythmias and ion channelopathies in Hispanic populations. Current research also sheds light on disparities in overall healthcare quality in Indigenous populations. The available yet limited literature underscores the pressing need for more extensive and comprehensive research on cardiac ion channelopathies in Hispanic/Latino and Indigenous populations. Specifically, additional studies are essential to fully characterize pathogenic genetic variants, identify population‐specific risk factors, and address health disparities to enhance the detection, prevention, and management of arrhythmias and sudden cardiac death in these demographic groups.

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“…Kiernan et al 16 present the racial and ethnic differences in implantation of ICDs. They report that most clinical trials differentiate race as white or non-white, thus largely ignoring subgroups such as African Americans, Hispanics, or Native Americans.…”

mentioning

confidence: 99%

Special issue on electrophysiology and arrhythmia management around the globe: Challenges and opportunities explored

Srivatsa

2022

Heart Rhythm O2

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Racial and ethnic differences in implantable cardioverter-defibrillator patient selection, management, and outcomes

Cited by 5 publications

References 74 publications

Racial and Ethnic Disparities in the Utilization and Outcomes with WATCHMAN FLX: A SURPASS analysis of the NCDR LAAO Registry

Racial and Ethnic Disparities in the Utilization and Outcomes with WATCHMAN FLX: A SURPASS analysis of the NCDR LAAO Registry

Arrhythmias and ion channelopathies causing sudden cardiac death in Hispanic/Latino and Indigenous populations

Special issue on electrophysiology and arrhythmia management around the globe: Challenges and opportunities explored

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