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Sex and Race Disparities in Hypertrophic Cardiomyopathy: Unequal Implantable Cardioverter-Defibrillator Use During

Sri Harsha Patlolla1, Hartzell V Schaff2, Rick A Nishimura3

  • 1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN.

Mayo Clinic Proceedings
|December 11, 2021
PubMed

Insights

Implantable cardioverter-defibrillator (ICD) use for hypertrophic cardiomyopathy (HCM) is lower in women and racial minorities. These groups also experience more complications and higher healthcare costs, indicating significant disparities in care.

Area of Science:

  • Cardiology
  • Public Health
  • Health Disparities

Background:

  • Hypertrophic cardiomyopathy (HCM) is a significant cause of sudden cardiac death.
  • Implantable cardioverter-defibrillators (ICDs) are crucial for preventing sudden cardiac death in high-risk HCM patients.
  • Existing research suggests potential disparities in healthcare access and utilization based on sex and race.

Purpose of the Study:

  • To investigate sex and race disparities in the utilization of ICDs for sudden cardiac death prevention in patients diagnosed with HCM.
  • To identify if demographic factors influence the implantation rates of ICDs in HCM patients.

Main Methods:

  • Analysis of adult hospitalizations for HCM from the National Inpatient Sample (2003-2014).
  • Identification of patients who received an ICD implantation.
  • Classification of race as White versus non-White and evaluation of sex differences.

Main Results:

  • ICD implantation occurred in 16.8% of 23,535 HCM hospitalizations, with an increasing trend over time.
  • Female sex and non-White race were independently associated with lower odds of receiving an ICD.
  • Women and non-White patients experienced higher rates of device-related complications, longer hospital stays, and increased costs.

Conclusions:

  • ICD devices are underutilized in women and racial minorities with HCM, irrespective of other patient or hospital factors.
  • These disparities contribute to worse outcomes, including higher complication rates and greater resource utilization for underrepresented groups.
  • Addressing these disparities is critical for equitable prevention of sudden cardiac death in HCM patients.
Abstract

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