Women and minorities are less likely to receive an implantable cardioverter defibrillator for primary prevention of sudden cardiac death

Mezu, Ure; Ch, Iftikhar; Halder, Indrani; London, Barry; Saba, Samir

doi:10.1093/europace/eur360

Cited by 39 publications

(32 citation statements)

References 24 publications

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Section: Discussioncontrasting

confidence: 51%

“…Other studies have also shown that older patients 23,24 and women 25,26 are less likely to receive an ICD, with race also being a determinant. 27 In the present study, we did not observe any sex or race differences.The presence of significant comorbidities in a subgroup (26%), especially neuropsychiatric comorbidities 23 and chronic dialysis, may have influenced the decision to implant a primary ICD, and most ICD trials have excluded patients with significant comorbidity. This could reflect provider judgment, patient preference, or possibly impairment of the patient's decision-making ability.…”

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confidence: 51%

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Frequency and Determinants of Implantable Cardioverter Defibrillator Deployment Among Primary Prevention Candidates With Subsequent Sudden Cardiac Arrest in the Community

et al. 2013

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Background-The prevalence rates and influencing factors for deployment of primary prevention implantable cardioverter defibrillators (ICDs) among subjects who eventually experience sudden cardiac arrest in the general population have not been evaluated. Methods and Results-Cases of adult sudden cardiac arrest with echocardiographic evaluation before the event were identified from the ongoing Oregon Sudden Unexpected Death Study (population approximately 1 million). Eligibility for primary ICD implantation was determined from medical records based on established guidelines. The frequency of prior primary ICD implantation in eligible subjects was evaluated, and ICD nonrecipients were characterized. Of 2093 cases (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012), 448 had appropriate pre-sudden cardiac arrest left ventricular ejection fraction information available. Of these, 92 (20.5%) were eligible for primary ICD implantation, 304 (67.9%) were ineligible because of left ventricular ejection fraction >35%, and the remainder (52, 11.6%) had left ventricular ejection fraction ≤35% but were ineligible on the basis of clinical guideline criteria. Among eligible subjects, only 12 (13.0%; 95% confidence interval, 6.1%-19.9%) received a primary ICD. Compared with recipients, primary ICD nonrecipients were older (age at ejection fraction assessment, 67.1±13.6 versus 58.5±14.8 years, P=0.05), with 20% aged ≥80 years (versus 0% among recipients, P=0.11). Additionally, a subgroup (26%) had either a clinical history of dementia or were undergoing chronic dialysis. Conclusions-Only one fifth of the sudden cardiac arrest cases in the community were eligible for a primary prevention ICD before the event, but among these, a small proportion (13%) were actually implanted. Although older age and comorbidity may explain nondeployment in a subgroup of these cases, other determinants such as socioeconomic factors, health insurance, patient preference, and clinical practice patterns warrant further detailed investigation. Key Words: death, sudden ◼ epidemiology ◼ heart arrest ◼ implantable defibrillators ◼ population ◼ utilization © 2013 American Heart Association, Inc.Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.113.002539Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz. Received March 11, 2013; accepted August 21, 2013. From The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (K.N., K.R., A.U.-E., C.T., H.C., E.M., S.S.C.); and Departments of Pathology (K.G.) and Emergency Medicine (J.J.), Oregon Health and Science University, Portland, OR.Correspondence to Sumeet S. Chugh, MD, Cedars-Sinai Medical Center, The Heart Institute, AHSP Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, Los Angeles, CA 90048. E-mail sumeet.chugh@cshs.org be significantly underused in the community for both primary and secondary prevention. [13][14][15] However, the extent of deployment of the primary ICD amon...

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Section: Discussioncontrasting

confidence: 51%

contrasting

confidence: 51%

Frequency and Determinants of Implantable Cardioverter Defibrillator Deployment Among Primary Prevention Candidates With Subsequent Sudden Cardiac Arrest in the Community

et al. 2013

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“…Additional research has demonstrated that lifesaving therapies such as implantable cardioverter-defibrillators (ICDs) are underutilized in African Americans(9). While there has been an overall trend towards improved utilization of ICDs in all survivors of SCD (10), African American patients are still less likely than Caucasians to receive an ICD for primary prevention of SCA (11). …”

Section: Socioeconomic Factors and Racial Disparitiesmentioning

confidence: 99%

Racial differences in sudden cardiac death

Fender

Henrikson

Tereshchenko

2014

Journal of Electrocardiology

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There is an increased risk of sudden cardiac death (SCD) and sudden cardiac arrest (SCA), in African Americans, the basis of which is likely multifactorial. African Americans have higher rates of traditional cardiac risk factors including hypertension, left ventricular hypertrophy, diabetes, coronary heart disease, and heart failure. There are also significant disparities in health care delivery. While these factors undoubtedly affect health outcomes, there is also growing evidence that genetics may have a significant impact as well. In this paper, we discuss data and hypotheses in support of both sides of the controversy around racial differences in SCD/SCA.

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“…9-13 While these care differences appear to have lessened over time, they persist in contemporary practice. 14 It is unclear whether these differences result from a lack of empirical data on long-term effectiveness of ICDs in minority patients.…”

Section: Introductionmentioning

confidence: 99%

Primary Prevention Implantable Cardioverter-Defibrillators in Older Racial and Ethnic Minority Patients

Pokorney

Hellkamp

Yancy

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background Racial and ethnic minorities are underrepresented in clinical trials of primary prevention implantable cardioverter-defibrillators (ICDs). This analysis investigates the association between primary prevention ICDs and mortality among Medicare, racial/ethnic minority patients. Methods and Results Data from Get With The Guidelines-Heart Failure Registry and National Cardiovascular Data Registry's-ICD Registry were used to perform an adjusted comparative effectiveness analysis of primary prevention ICDs in Medicare, racial/ethnic minority patients (non-white race or Hispanic ethnicity). Mortality data were obtained from the Medicare denominator file. The relationship of ICD to survival was compared between minority and white non-Hispanic patients. Our analysis included 852 minority patients, 426 ICD and 426 matched non-ICD patients, and 2,070 white non-Hispanic patients (1,035 ICD and 1,035 matched non-ICD patients). Median follow-up was 3.1 years. Median age was 73 years, and median ejection fraction was 23%. Adjusted 3-year mortality rates for minority ICD and non-ICD patients were 44.9% (95% CI: 44.2-45.7%) and 54.3% (95% CI: 53.4-55.1%), respectively (adjusted HR 0.79, CI: 0.63-0.98, p=0.034). White non-Hispanic patients receiving an ICD had lower adjusted 3-year mortality rates of 47.8% (95% CI: 47.3-48.3%) compared with 57.3% (95% CI: 56.8-57.9%) for those with no ICD (adjusted HR 0.75, 95% CI 0.67-0.83, p<0.0001). There was no significant interaction between race/ethnicity and lower mortality risk with ICD (p=0.70). Conclusions Primary prevention ICDs are associated with lower mortality in non-white and Hispanic patients, similar to that seen in white, non-Hispanic patients. These data support a similar approach to ICD patient selection, regardless of race or ethnicity.

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Women and minorities are less likely to receive an implantable cardioverter defibrillator for primary prevention of sudden cardiac death

Abstract: Even after adjusting for comorbid conditions, gender, and racial discrepancies in the implantation of ICDs for the primary prevention of sudden cardiac death exist. Further investigations into the root causes of these discrepancies are needed before any corrective measures can be adopted.

Cited by 39 publications

References 24 publications

Frequency and Determinants of Implantable Cardioverter Defibrillator Deployment Among Primary Prevention Candidates With Subsequent Sudden Cardiac Arrest in the Community

Frequency and Determinants of Implantable Cardioverter Defibrillator Deployment Among Primary Prevention Candidates With Subsequent Sudden Cardiac Arrest in the Community

Racial differences in sudden cardiac death

Primary Prevention Implantable Cardioverter-Defibrillators in Older Racial and Ethnic Minority Patients

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