Results of a clinical trial show stark disparities in the use of life-saving implantable cardioverter defibrillator (ICD) interventions based on sex and race, suggesting a potential bias in care pathways by electrophysiologists (EPs). The study was presented online as part of Heart Rhythm Society 2020 Science.
“When you consider the number of patients overall who are at risk of a cardiac event or have already survived a life-threatening cardiac event, the use of implantable cardioverter defibrillators is staggeringly low, and the disparities in use by sex and race are unmistakable,” said lead author Anne Curtis (University at Buffalo, New York, USA) .“Our hope is that these results will help physicians better identify patients who would benefit from guideline-directed device therapies and make sure that they receive this indicated and life-saving intervention.”
Among high-risk patients who have survived a life-threatening cardiac event, and therefore meet indications for ICDs, only 41% get ICDs. Patients who could use ICD therapy as primary prevention of a cardiac event, only get an ICD 8.3% of the time, the study’s authors suggest. As most ICDs are recommended and implanted by EPs, the study sought to examine real-world data to see how EP consultations impact disparities in ICD use by sex and race.
The trial included 159,009 patients (following screening procedures on electronic health records (EHR) of 2.9 million patients with any cardiac disease, arrhythmia or syncope, from 47 healthcare systems in the USA) and included data on diagnoses, procedures, measures, prescriptions, labs and encounters. These were de-identified EHR data curated by Optum, where both the patient and providers were anonymous.
Patient inclusion criteria included: new Class I or IIa indication for ICDs or CRT-D from 2012-2016; had >1 year of records prior to indication; aged <79 years. The trial looked at study groups, including differences in EP visits race and sex.
When looking at EP visits by sex, the trial found that among the 159,099 patients with a guideline directed device therapy (GDDT) indication, more men (54.7%) than women (51.2%) saw an EP. Among the 84,943 patients seen by an EP, more men (28.1%) than women (23.0%) received GDDT. When looking at the same information by race, the majority of White patients (55.5%) saw an EP, while patients of other races, including Asian, Black and Hispanic, (46.9%) did not. Among patients seen by an EP, fewer White patients (25.9%) received GDDT than patients of other races (27.9%).
The authors of the study call for quality improvement programmes to be developed in healthcare systems. Through additional research, the authors also hope to continue analysing the data to discover additional insights on the use of ICDs.
The 2020 Heart Rhythm Scientific Session (HRS 2020) had originally been scheduled to take place 6–9 May in San Diego, USA. Due to the impact of the COVID-19 pandemic, the event has been switched to a digital platform.