Racial and Ethnic Disparities in Implantable Cardioverter-Defibrillator Utilization: A Contemporary Review

Area of Science:

• Cardiology
• Health Disparities Research
• Public Health

Background:

• Sudden cardiac arrest (SCA) carries significant morbidity and mortality.
• Racially minoritized populations experience a disproportionate burden of sudden cardiac death (SCD).
• Eligible racially minoritized patients have lower rates of implantable cardioverter-defibrillator (ICD) therapy for SCD prevention.

Purpose of the Study:

• To review racial and ethnic disparities in ICD utilization.
• To identify barriers to ICD care for racially minoritized patients.
• To propose interventions for equitable ICD uptake.

Main Methods:

• Literature review of studies examining ICD utilization across racial and ethnic groups.
• Analysis of patient, provider, health system, and societal factors contributing to disparities.
• Synthesis of proposed interventions to improve equitable access to ICD therapy.

Main Results:

• Racially minoritized populations are disproportionately eligible for ICD therapy but receive it less frequently.
• Barriers include reduced access to cardiac specialists, less counseling on ICDs, and lower implantation rates.
• Disparities are multifactorial, stemming from patient, provider, health system, and societal influences.

Conclusions:

• Racial and ethnic disparities in ICD use for SCD prevention are well-documented.
• Interventions must focus on equitable care delivery, increased diversity in trials and workforce, and addressing historical injustices.
• Prioritizing access for racially minoritized patients is essential for reducing SCD mortality.