Paul L Hess1, Adrian F Hernandez2, Deepak L Bhatt2, Anne S Hellkamp2, Clyde W Yancy2, Lee H Schwamm2, Eric D Peterson2, Phillip J Schulte2, Gregg C Fonarow2, Sana M Al-Khatib2. 1. From VA Eastern Colorado Health Care System and Department of Medicine, University of Colorado School of Medicine, Denver (P.L.H.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., A.S.H., E.D.P., P.J.S., S.M.A.-K.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston (L.H.S.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles (G.C.F.). paul.hess@ucdenver.edu. 2. From VA Eastern Colorado Health Care System and Department of Medicine, University of Colorado School of Medicine, Denver (P.L.H.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., A.S.H., E.D.P., P.J.S., S.M.A.-K.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston (L.H.S.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles (G.C.F.).
Abstract
BACKGROUND: Previous studies have found that women and black patients eligible for a primary prevention implantable cardioverter-defibrillator (ICD) are less likely than men or white patients to receive one. METHODS: We performed an observational analysis of the Get With The Guidelines-Heart Failure Program from January 1, 2011, to March 21, 2014. Patients admitted with heart failure and an ejection fraction ≤35% without an ICD were included. Rates of ICD counseling among eligible patients and ICD receipt among counseled patients were examined by sex and race/ethnicity. RESULTS: Among 21 059 patients from 236 sites, 4755 (22.6%) received predischarge ICD counseling. Women were counseled less frequently than men (19.3% versus 24.6%, P<0.001, adjusted odds ratio [OR], 0.84; 95% confidence interval [CI], 0.78-0.91). Racial and ethnic minorities were less likely to receive counseling than white patients (black 22.6%, Hispanic 18.6%, other race/ethnic group 14.4% versus white 24.3%, P<0.001 for each): adjusted OR versus white, 0.69; 95% CI, 0.63 to 0.76 for black patients; adjusted OR, 0.62; 95% CI, 0.55 to 0.70 for Hispanic patients; adjusted OR, 0.53; 95% CI, 0.43 to 0.65 for other patients. Among the 4755 counseled patients, 2977 (62.6%) received an ICD or had one planned for placement after hospital stay. Among those counseled, women and men were similarly likely to receive an ICD (adjusted OR, 1.13; 95% CI, 0.99-1.29). However, black (adjusted OR, 0.70; 95% CI, 0.56-0.88) and Hispanic patients (adjusted OR, 0.68; 95% CI, 0.46-1.01) were less likely to receive an ICD. CONCLUSIONS: Up to 4 of 5 hospitalized patients with heart failure eligible for ICD counseling did not receive it, particularly women and minority patients. Among counseled patients, ICD use differences by race and ethnicity persisted.
BACKGROUND: Previous studies have found that women and black patients eligible for a primary prevention implantable cardioverter-defibrillator (ICD) are less likely than men or white patients to receive one. METHODS: We performed an observational analysis of the Get With The Guidelines-Heart Failure Program from January 1, 2011, to March 21, 2014. Patients admitted with heart failure and an ejection fraction ≤35% without an ICD were included. Rates of ICD counseling among eligible patients and ICD receipt among counseled patients were examined by sex and race/ethnicity. RESULTS: Among 21 059 patients from 236 sites, 4755 (22.6%) received predischarge ICD counseling. Women were counseled less frequently than men (19.3% versus 24.6%, P<0.001, adjusted odds ratio [OR], 0.84; 95% confidence interval [CI], 0.78-0.91). Racial and ethnic minorities were less likely to receive counseling than white patients (black 22.6%, Hispanic 18.6%, other race/ethnic group 14.4% versus white 24.3%, P<0.001 for each): adjusted OR versus white, 0.69; 95% CI, 0.63 to 0.76 for black patients; adjusted OR, 0.62; 95% CI, 0.55 to 0.70 for Hispanic patients; adjusted OR, 0.53; 95% CI, 0.43 to 0.65 for other patients. Among the 4755 counseled patients, 2977 (62.6%) received an ICD or had one planned for placement after hospital stay. Among those counseled, women and men were similarly likely to receive an ICD (adjusted OR, 1.13; 95% CI, 0.99-1.29). However, black (adjusted OR, 0.70; 95% CI, 0.56-0.88) and Hispanic patients (adjusted OR, 0.68; 95% CI, 0.46-1.01) were less likely to receive an ICD. CONCLUSIONS: Up to 4 of 5 hospitalized patients with heart failure eligible for ICD counseling did not receive it, particularly women and minority patients. Among counseled patients, ICD use differences by race and ethnicity persisted.
Authors: Rebecca S Steinberg; Aditi Nayak; Celena O'Connell; Sharon Burford; Ann Pekarek; Neile Chesnut; Robert T Cole; Divya Gupta; S Raja Laskar; Kunal Bhatt; Michael Burke; Tamer Attia; Andrew Smith; J David Vega; Alanna A Morris Journal: Clin Transplant Date: 2020-03-16 Impact factor: 2.863
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Authors: Paul A Heidenreich; Gregg C Fonarow; Khadijah Breathett; Corrine Y Jurgens; Barbara A Pisani; Bunny J Pozehl; John A Spertus; Kenneth G Taylor; Jennifer T Thibodeau; Clyde W Yancy; Boback Ziaeian Journal: Circ Cardiovasc Qual Outcomes Date: 2020-11-02
Authors: Paul A Heidenreich; Gregg C Fonarow; Khadijah Breathett; Corrine Y Jurgens; Barbara A Pisani; Bunny J Pozehl; John A Spertus; Kenneth G Taylor; Jennifer T Thibodeau; Clyde W Yancy; Boback Ziaeian Journal: J Am Coll Cardiol Date: 2020-11-02 Impact factor: 24.094