Management of ventricular arrhythmias in diverse populations in California.
BACKGROUND
The use of coronary angiography and revascularization is lower than expected among black patients. It is uncertain whether use of other cardiac procedures also varies according to race and ethnicity and whether outcomes are affected.


METHODS
We analyzed discharge abstracts from all nonfederal hospitals in California of patients hospitalized for a primary diagnosis of ventricular tachycardia or ventricular fibrillation between 1992 and 1994. We compared mortality rates and use of electrophysiologic study (EPS) and implantable cardioverter-defibrillator (ICD) procedures according to the race and ethnicity of the patient.


RESULTS
Among 8713 patients admitted with ventricular tachycardia or ventricular fibrillation, 29% (n = 2508) had a subsequent EPS procedure, and 9% (n = 818) had an ICD implanted. After controlling for potential confounding factors, we found that black patients were significantly less likely than white patients to undergo EPS (odds ratio 0.72, CI 0.56-0.92) or ICD implantation (odds ratio 0.39, CI 0.25-0.60). Blacks discharged alive from the initial hospital admission had higher mortality rates over the next year than white patients, even after controlling for multiple confounding risk factors (risk ratio 1.18, CI 1.03-1.36). The use of EPS and ICD procedures was also significantly affected by several other factors, most notably by on-site procedure availability but also by age, sex, and insurance status.


CONCLUSIONS
In a large population of patients hospitalized for ventricular arrhythmia, blacks had significantly lower rates of utilization for EPS and ICD procedures and higher subsequent mortality rates.
Alexander
Mark
M
Medical Effectiveness Research Center for Diverse Populations, Department of Medicine, University of California, San Francisco, Calif, USA.
Baker
Laurence
L
Clark
Cheryl
C
McDonald
Kathryn M
KM
Rowell
Richard
R
Saynina
Olga
O
Hlatky
Mark A
MA
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D044383:Black People; D002140:California / Q000453:epidemiology / Q000208:ethnology; D015331:Cohort Studies; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D022062:Electrophysiologic Techniques, Cardiac / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D044469:Racial Groups; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*