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Management of ventricular arrhythmias in diverse populations in California
Mark Alexander1, Laurence Baker, Cheryl Clark
1Medical Effectiveness Research Center for Diverse Populations, Department of Medicine, University of California, San Francisco, Calif, USA.
Insights
Black patients with ventricular arrhythmias received fewer electrophysiologic studies (EPS) and implantable cardioverter-defibrillator (ICD) procedures. These patients also experienced higher mortality rates within a year, indicating disparities in cardiac care.
Area of Science:
- Cardiology
- Health Disparities
- Medical Outcomes
Background:
- Previous studies indicate lower use of coronary angiography and revascularization in Black patients.
- It remains unclear if other cardiac procedures and their outcomes differ by race and ethnicity.
Purpose of the Study:
- To investigate racial and ethnic variations in the utilization of electrophysiologic study (EPS) and implantable cardioverter-defibrillator (ICD) procedures.
- To examine the impact of race and ethnicity on mortality rates among patients hospitalized for ventricular tachycardia or fibrillation.
Main Methods:
- Analysis of discharge abstracts from California nonfederal hospitals (1992-1994).
- Inclusion criteria: patients hospitalized with a primary diagnosis of ventricular tachycardia or ventricular fibrillation.
- Comparison of mortality rates and procedural utilization (EPS, ICD) across racial and ethnic groups.
Main Results:
- Among 8713 patients, 29% underwent EPS and 9% received an ICD.
- Black patients were significantly less likely than white patients to undergo EPS (OR 0.72) or ICD implantation (OR 0.39), even after adjusting for confounding factors.
- Black patients discharged alive had higher 1-year mortality rates (RR 1.18) than white patients, irrespective of risk factors.
- Procedure availability, age, sex, and insurance status also influenced EPS and ICD use.
Conclusions:
- Black patients hospitalized for ventricular arrhythmias exhibit lower utilization rates of EPS and ICD procedures.
- These disparities in procedural care are associated with higher subsequent mortality rates in Black patients.
- Findings highlight significant racial disparities in advanced cardiac procedure utilization and outcomes.
Background:
The use of coronary angiography and revascularization is lower than expected among black patients. It is uncertain whether use of other cardiac procedures also varies according to race and ethnicity and whether outcomes are affected.
Methods:
We analyzed discharge abstracts from all nonfederal hospitals in California of patients hospitalized for a primary diagnosis of ventricular tachycardia or ventricular fibrillation between 1992 and 1994. We compared mortality rates and use of electrophysiologic study (EPS) and implantable cardioverter-defibrillator (ICD) procedures according to the race and ethnicity of the patient.
Results:
Among 8713 patients admitted with ventricular tachycardia or ventricular fibrillation, 29% (n = 2508) had a subsequent EPS procedure, and 9% (n = 818) had an ICD implanted. After controlling for potential confounding factors, we found that black patients were significantly less likely than white patients to undergo EPS (odds ratio 0.72, CI 0.56-0.92) or ICD implantation (odds ratio 0.39, CI 0.25-0.60). Blacks discharged alive from the initial hospital admission had higher mortality rates over the next year than white patients, even after controlling for multiple confounding risk factors (risk ratio 1.18, CI 1.03-1.36). The use of EPS and ICD procedures was also significantly affected by several other factors, most notably by on-site procedure availability but also by age, sex, and insurance status.
Conclusions:
In a large population of patients hospitalized for ventricular arrhythmia, blacks had significantly lower rates of utilization for EPS and ICD procedures and higher subsequent mortality rates.
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