BACKGROUND: Racial/ethnic differences in the use of cardiac resynchronization therapy with defibrillator (CRT-D) may result from underprovision or overprovision relative to published guidelines. OBJECTIVE: The purpose of this study was to examine the National Cardiovascular Data Registry (NCDR) ICD Registry for ethnic/racial differences in use of CRT-D. METHODS: We studied white, black, and Hispanic patients who received either an implantable cardioverter-defibrillator (ICD) or CRT-D between January 2005 and April 2007. Two multivariate logistic regression models were fit with the following outcome variables: (1) receipt of either ICD or CRT-D and (2) receipt of CRT-D outside of published guidelines. RESULTS: Of 108,341 registry participants, 22,205 met inclusion criteria for the first analysis and 27,165 met criteria for the second analysis. Multivariate analysis indicated CRT-eligible black (odds ratio [OR] 0.84; 95% confidence interval [CI], 0.75-0.95; P <.004) and Hispanic (OR 0.83; 95% CI, 0.71-0.99; P <.033) patients were less likely to receive CRT-D than were white patients. A substantial proportion of patients received CRT-D outside of published guidelines, although black (OR 1.18; 95% CI, 1.02-1.36; P = .001) and Hispanic (OR 1.17; 95% CI, 1.02-1.36; P = .03) patients were more likely to meet all three eligibility criteria. CONCLUSION: Black and Hispanic patients who were eligible for CRT-D were less likely to receive therapy compared with white patients. Conversely, in the context of widespread out-of-guideline use of CRT-D, black and Hispanic patients were more likely to meet established criteria. Our findings suggest systematic racial/ethnic differences in the treatment of patients with advanced heart failure.
BACKGROUND: Racial/ethnic differences in the use of cardiac resynchronization therapy with defibrillator (CRT-D) may result from underprovision or overprovision relative to published guidelines. OBJECTIVE: The purpose of this study was to examine the National Cardiovascular Data Registry (NCDR) ICD Registry for ethnic/racial differences in use of CRT-D. METHODS: We studied white, black, and Hispanic patients who received either an implantable cardioverter-defibrillator (ICD) or CRT-D between January 2005 and April 2007. Two multivariate logistic regression models were fit with the following outcome variables: (1) receipt of either ICD or CRT-D and (2) receipt of CRT-D outside of published guidelines. RESULTS: Of 108,341 registry participants, 22,205 met inclusion criteria for the first analysis and 27,165 met criteria for the second analysis. Multivariate analysis indicated CRT-eligible black (odds ratio [OR] 0.84; 95% confidence interval [CI], 0.75-0.95; P <.004) and Hispanic (OR 0.83; 95% CI, 0.71-0.99; P <.033) patients were less likely to receive CRT-D than were white patients. A substantial proportion of patients received CRT-D outside of published guidelines, although black (OR 1.18; 95% CI, 1.02-1.36; P = .001) and Hispanic (OR 1.17; 95% CI, 1.02-1.36; P = .03) patients were more likely to meet all three eligibility criteria. CONCLUSION: Black and Hispanic patients who were eligible for CRT-D were less likely to receive therapy compared with white patients. Conversely, in the context of widespread out-of-guideline use of CRT-D, black and Hispanic patients were more likely to meet established criteria. Our findings suggest systematic racial/ethnic differences in the treatment of patients with advanced heart failure.
Authors: Boback Ziaeian; Yan Zhang; Nancy M Albert; Anne B Curtis; Mihai Gheorghiade; J Thomas Heywood; Mandeep R Mehra; Christopher M O'Connor; Dwight Reynolds; Mary Norine Walsh; Clyde W Yancy; Gregg C Fonarow Journal: J Am Coll Cardiol Date: 2014-08-26 Impact factor: 24.094
Authors: Sana M Al-Khatib; Anne Hellkamp; Jeptha Curtis; Daniel Mark; Eric Peterson; Gillian D Sanders; Paul A Heidenreich; Adrian F Hernandez; Lesley H Curtis; Stephen Hammill Journal: JAMA Date: 2011-01-05 Impact factor: 56.272
Authors: Khadijah Breathett; Wenhui G Liu; Larry A Allen; Stacie L Daugherty; Irene V Blair; Jacqueline Jones; Gary K Grunwald; Marc Moss; Tyree H Kiser; Ellen Burnham; R William Vandivier; Brendan J Clark; Eldrin F Lewis; Sula Mazimba; Catherine Battaglia; P Michael Ho; Pamela N Peterson Journal: JACC Heart Fail Date: 2018-05 Impact factor: 12.035
Authors: Khadijah Breathett; Erika Yee; Natalie Pool; Megan Hebdon; Janice D Crist; Ryan H Yee; Shannon M Knapp; Sade Solola; Luis Luy; Kathryn Herrera-Theut; Leanne Zabala; Jeff Stone; Marylyn M McEwen; Elizabeth Calhoun; Nancy K Sweitzer Journal: JAMA Netw Open Date: 2020-07-01