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Published on: February 28, 2012
Persistent sex disparities in implantable cardioverter-defibrillator therapy
Amber E Johnson1, Shubash Adhikari1, Andrew D Althouse1
1University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Insights
Women with heart failure receive fewer implantable cardioverter-defibrillators (ICDs) than men, despite clinical guidelines. While racial disparities in ICD use have lessened, sex-based inequities persist, requiring further investigation.
Area of Science:
- Cardiology
- Health Disparities
- Medical Device Implantation
Background:
- Clinical guidelines advocate for implantable cardioverter-defibrillators (ICDs) in heart failure patients with reduced ejection fraction.
- Existing data indicate underrepresentation of women and minority groups in ICD therapy compared to white men.
- This study investigates contemporary race and sex disparities in ICD implantation.
Purpose of the Study:
- To examine persistent race and sex differences in the utilization of implantable cardioverter-defibrillator (ICD) therapy.
- To assess the prevalence of ICDs among patients with heart failure and reduced ejection fraction, stratified by race and sex.
- To identify potential disparities in access to recommended cardiac device therapy.
Main Methods:
- Retrospective analysis of outpatient electronic medical records from a large health system in 2014.
- Inclusion criteria: patients aged ≥18 years with ejection fraction ≤ 35%.
- Multivariable logistic regression was used to adjust for confounding factors like age, medications, and comorbidities.
Main Results:
- Out of 5,156 eligible patients, 32.6% had an ICD.
- Women were significantly less likely to have an ICD than men (25.0% vs 36.3%, P < 0.01).
- While initial analysis showed Black patients were less likely to have an ICD than white patients (28.0% vs 33.2%, P = 0.02), this difference was not significant after adjustment (OR = 0.86, P = 0.18).
Conclusions:
- Sex-based disparities in ICD implantation persist in a contemporary outpatient cohort.
- Racial differences in ICD prevalence were attenuated after adjusting for clinical variables.
- Further research is necessary to elucidate the reasons behind the ongoing sex disparities in ICD therapy.
Background:
Clinical guidelines recommend cardioverter defibrillator implantation for patients with heart failure and reduced ejection fraction. Despite this, women and minorities have been less likely to receive implantable cardioverter-defibrillator (ICD) therapy than white men. We examined race and sex differences in ICD implantation in a recent cohort.
Methods:
Using cross-sectional, retrospective analyses, we mined our health system's outpatient electronic medical records to assess age, race, sex, medications, and comorbidities for patients aged ≥18 years with ejection fraction ≤ 35% during 2014. While adjusting for confounding variables such as medications, age, and comorbidities, we conducted a multivariable logistic regression assessing whether racial and sex differences in ICD therapy persist.
Results:
Among 5,156 outpatients with ejection fraction ≤35%, 1,681 (32.6%) patients had an ICD present at the time of their index outpatient visit in 2014. Women were less likely to have an ICD than men (25.0% vs 36.3%, P < 0.01), and black patients were less likely to have an ICD than white patients (28.0% vs 33.2%, P = 0.02). In adjusted multivariable analyses, women were less like to have ICDs (adjusted odds ratio [OR] = 0.68, 95% confidence interval [CI], 0.58-0.79, P < 0.01) but the race difference dissipated (adjusted OR for black race = 0.86, 95% CI, 0.68-1.08, P = 0.18).
Conclusions:
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.
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