Author + information
- Amber E. Johnsona,b,
- Shubash Adhikaria,b,
- Andrew Althousea,b,
- Floyd Thomaa,b,
- Oscar Marroquina,b,
- Stephen Koscomba,b,
- Leslie Hausmanna,b,
- Larissa Myaskovskya,b and
- Samir Sabaa,b
Background: Historically, women and minorities have been less likely to receive implantable cardioverter-defibrillator (ICD) therapy than white men, despite guidelines establishing ICD use as a Class I indication for patients with heart failure and reduced ejection fraction (EF). We examined whether disparities in ICD implantation persist in a recent cohort of patients with reduced EF.
Methods: Using electronic medical records, we assessed age, race, and gender, medications, comorbidities, and ICD presence for all patients aged 18 years and older with EF ≤ 35% at a large non-profit academic health system during calendar year 2014.
Results: The analysis included 5247 patients, of which 1707 (32.5%) had an ICD. Women were less likely to have an ICD than men (25.0% vs 36.3%, p<0.01). Black patients were also less likely to have an ICD than White patients (28.0% vs 33.2%, p=0.02).
In multivariable analyses adjusting for race, gender, age, medications, and comorbidities, the relationship persisted for gender (adjusted OR=0.68, 95% CI 0.58-0.79, p<0.01) but not for race (adjusted OR=0.86, 95% CI 0.68-1.08, p=0.18). Other factors associated with likelihood of ICD presence were osteoporosis (adjusted OR=0.66, 95% CI 0.44-0.97, p=0.03), active cancer (adjusted OR=0.81, 95% CI 0.64-1.00, p=0.05), CHF (OR=2.66, 95% CI 2.19-3.23, p<0.01), and VT/VF (OR=13.6, 95% CI 11.0-16.9, p<0.01). In addition, being on guideline-indicated medications including beta blockers, ACEi/ARB, aldosterone antagonists, diuretics, potassium-sparing diuretics, statins, and digoxin was associated with ICD presence (all p-values < 0.001).
Conclusions: In this single-center retrospective analysis, gender disparities in ICD persist despite published guidelines and national heart failure quality improvement initiatives. Frailty (osteoporosis) and poor prognosis (cancer diagnosis) may also be reasons that a patient does not receive ICD therapy when clinically indicated, but these do not explain less use of ICD among women. Differing physician referral, patient preference, or sociodemographic factors could be contributing to this disparity and should be evaluated.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias and Clinical EP: Devices 2
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1149-074
- 2017 American College of Cardiology Foundation