Do gender differences persist in ICD implantation in patients with acute on chronic heart failure?

Implantable Cardiac Defibrillators (ICDs) prolong survival in patients with heart failure with reduced ejection fraction (HFrEF). Despite strong data suggesting their benefit, there is concern for disparities related to ICD implantation rates.

A retrospective analysis of 551 patients admitted to a single tertiary institution from June 2020 to May 2023, who met the guideline criteria for ICD implantation for primary prevention of sudden cardiac death, was carried out.

Our population constituted of 56% African Americans, 20% Caucasians, 1% Asians and 2% Native Americans. Of those patients, 47% (157/337) of males and 33% (71/213) of females underwent ICD implantation before discharge, creating a statistically significant gender difference at p = 0.007. Patients aged 50 or greater (218/509) were more likely to receive an ICD compared to younger patients (10/41) at p = 0.000. Of those offered an ICD, 46% deferred to outpatient, 30% refused, and 8% of patient had history of noncompliance, were medically unstable, or were undecided.

Females and younger patients were less likely to have an ICD at discharge. Despite strong recommendations for ICD implantation in eligible patients, most patients did not receive an ICD. This study showcases the limited access to care and highlights potential avenues of improvement.