Long-term cardiovascular outcomes among immigrants and non-immigrants in cardiac resynchronization therapy: a
Johanna Krøll1, Søren Lund Kristensen1, Camilla H B Jespersen1
1Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Insights
Cardiac resynchronization therapy (CRT) shows similar effectiveness for immigrants and non-immigrants regarding heart failure hospitalizations and overall mortality. However, Middle Eastern immigrants experienced higher mortality rates post-CRT.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Outcomes for immigrants receiving cardiac resynchronization therapy (CRT) in Europe are not well-documented.
- Understanding disparities in CRT efficacy for heart failure (HF) patients is crucial for equitable care.
Purpose of the Study:
- To compare the effectiveness of CRT in immigrant and non-immigrant populations in Denmark.
- To evaluate differences in heart failure-related hospitalizations and all-cause mortality after CRT implantation.
Main Methods:
- Nationwide registry data from Denmark (2000-2017) identified patients undergoing first-time CRT implantation.
- Cox regression analyses assessed differences in HF hospitalizations and all-cause mortality over 5 years.
- Patient origins were categorized, with a focus on European, Middle Eastern, and other groups.
Main Results:
- CRT implantation rates were similar between immigrants (3.4%) and non-immigrants (3.5%).
- Both groups showed significant reductions in HF hospitalizations post-CRT (61% vs. 57% reduction).
- Overall 5-year mortality was comparable (24.1% vs. 25.8%), but immigrants from the Middle East had higher mortality (HR=2.2).
Conclusions:
- Cardiac resynchronization therapy demonstrates similar efficacy for immigrant and non-immigrant heart failure patients in Denmark.
- A notable exception is a higher mortality risk observed in immigrants of Middle Eastern origin.
- Cardiovascular causes predominated mortality across both groups.
Aims:
To date, potential differences in outcomes for immigrants and non-immigrants with a cardiac resynchronization therapy (CRT), in a European setting, remain underutilized and unknown. Hence, we examined the efficacy of CRT measured by heart failure (HF)-related hospitalizations and all-cause mortality among immigrants and non-immigrants.
Methods And Results:
All immigrants and non-immigrants who underwent first-time CRT implantation in Denmark (2000-2017) were identified from nationwide registries and followed for up to 5 years. Differences in HF related hospitalizations and all-cause mortality were evaluated by Cox regression analyses. From 2000 to 2017, 369 of 10 741 (3.4%) immigrants compared with 7855 of 223 509 (3.5%) non-immigrants with a HF diagnosis underwent CRT implantation. The origins of the immigrants were Europe (61.2%), Middle East (20.1%), Asia-Pacific (11.9%), Africa (3.5%), and America (3.3%). We found similar high uptake of HF guideline-directed pharmacotherapy before and after CRT and a consistent reduction in HF-related hospitalizations the year before vs. the year after CRT (61% vs. 39% for immigrants and 57% vs. 35% for non-immigrants). No overall difference in 5-year mortality among immigrants and non-immigrants was seen after CRT [24.1% and 25.8%, respectively, P-value = 0.50, hazard ratio (HR) = 1.2, 95% confidence interval (CI): 0.8-1.7]. However, immigrants of Middle Eastern origin had a higher mortality rate (HR = 2.2, 95% CI: 1.2-4.1) compared with non-immigrants. Cardiovascular causes were responsible for the majority of deaths irrespective of immigration status (56.7% and 63.9%, respectively).
Conclusion:
No overall differences in efficacy of CRT in improving outcomes between immigrants and non-immigrants were identified. Although numbers were low, a higher mortality rate among immigrants of Middle Eastern origin was identified compared with non-immigrants.
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