Socioeconomic status and geographic region affect patient access to ICDs in Asia—only 12% of eligible patients receive the therapy


There is a disparity between indications for and utilisation of implantable cardioverter defibrillators (ICDs) in Asian patients with heart failure, a recent study finds. The results come from a study authored by Yvonne May Fen Chia et al, recently published in Circulation.

Chia and her co-investigators used the prospective Asian sudden cardiac death in heart failure (ASIAN-HF) registry, which includes 5,276 symptomatic heart failure patients with reduced ejection fraction from 11 regions in Asia and across three income regions. A total of 3,240 patients (mean age 58.9±12.9 years, 79.1% men) were eligible for ICDs, as categorised in New York Heart Association (NYHA) Class II–III. Only 12% (389) of the ICD-eligible patients, however, received an ICD.

Chia et al distributed a survey to 2000 of the ICD-eligible non-recipients, and found that 55% were unaware of the benefits or needed more information on device therapy. Utilisation varied across Asian regions from 1.5% of ICD-eligible patients in Indonesia to 52.5% in Japan. Meanwhile, recipients of ICDs were found to be widely disparate across socioeconomic as well as geographical regions. ICD recipients were often older than non-recipients (63±11 vs. 58±13 year; p=<0.001), more educated (34.9% holding a tertiary education vs. 18.1% with primary education only; p=<0.001), and resided in higher income regions (64.5% vs. 36.5% in low income regions; p=<0.001).

The study also pointed to a trend in increased uptake where out-of-pocket expenditure was lower and government reimbursement available. Chia et al concluded, “Better patient education and targeted healthcare reforms in extending ICD reimbursement may improve access.”

The study assessed utilisation, clinical characteristics, perception and knowledge of ICDs at baseline, and followed patients for the primary outcome of all-cause mortality over a median of 417 days. ICDs were found to reduce risks of all-cause mortality (hazard ratio, 0.71; 95% confidence interval, 0.52–0.97) as well as sudden cardiac deaths (hazard ratio, 0.33; 95% confidence interval, 0.14–0.79).


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