Sex and Race/Ethnicity Differences in Implantable Cardioverter-Defibrillator Counseling and Use Among Patients
Paul L Hess1, Adrian F Hernandez2, Deepak L Bhatt2
1From VA Eastern Colorado Health Care System and Department of Medicine, University of Colorado School of Medicine, Denver (P.L.H.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., A.S.H., E.D.P., P.J.S., S.M.A.-K.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston (L.H.S.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles (G.C.F.). paul.hess@ucdenver.edu.
Women and minority patients eligible for primary prevention implantable cardioverter-defibrillators (ICDs) are less likely to receive counseling. Among those counseled, disparities in ICD receipt persist for Black and Hispanic patients.
Area of Science:
- Cardiology
- Health Disparities
- Medical Devices
Background:
- Previous studies indicate underrepresentation of women and Black patients in primary prevention implantable cardioverter-defibrillator (ICD) therapy.
- This disparity suggests potential inequities in patient selection and treatment pathways.
Purpose of the Study:
- To examine sex and race/ethnicity-based differences in ICD counseling and receipt among eligible heart failure patients.
- To identify potential barriers contributing to underutilization of ICDs in specific demographic groups.
Main Methods:
- Observational analysis of the Get With The Guidelines-Heart Failure Program (2011-2014).
- Inclusion criteria: hospitalized heart failure patients with ejection fraction ≤35% and no ICD.
- Analysis of ICD counseling rates and ICD receipt among counseled patients, stratified by sex and race/ethnicity.
Main Results:
- Only 22.6% of eligible patients received predischarge ICD counseling.
- Women (19.3%) and minority patients (Black: 22.6%, Hispanic: 18.6%) were less likely to be counseled than men (24.6%) and white patients (24.3%).
- Among counseled patients, Black (OR 0.70) and Hispanic (OR 0.68) patients were less likely to receive an ICD compared to white patients.
Conclusions:
- A significant proportion of eligible heart failure patients do not receive ICD counseling, with notable underrepresentation of women and minority groups.
- Despite counseling, disparities in ICD receipt persist based on race and ethnicity, highlighting ongoing inequities in cardiovascular care.
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