title: Racial disparity in the utilization of implantable-cardioverter defibrillators among patients with prior myocardial infarction and an ejection fraction of <or=35%.
abstract: Age-adjusted sudden cardiac death rates are highest for black patients compared with other racial groups. The prophylactic implantation of an implantable cardioverter-defibrillator (ICD) provides a significant reduction in sudden cardiac death and overall mortality in patients after myocardial infarctions with significant left ventricular systolic dysfunction. The purpose of this study was to determine whether black patients with left ventricular systolic dysfunction were less likely than white patients to receive ICDs for the primary prevention of sudden cardiac death. Data from the National Registry to Advance Heart Health (ADVANCENT) were analyzed to determine which patients with histories of myocardial infarctions and ejection fractions<or=35% received ICDs for the primary prevention of sudden cardiac death. Multivariate logistic regression was used to evaluate the association of patients' race with ICD implantation. Overall, 7,830 patients were identified as eligible candidates for ICDs. Black patients (n=660) were younger, more often women, had less education, had more co-morbidities, and had a lower mean ejection fraction compared with white patients (n=7,170). More than 90% of the study population were insured, and approximately 88% of participants in the registry were enrolled by cardiologists. Blacks were significantly less likely than whites to receive ICDs (30% vs 41%, p<0.001). This difference in ICD use persisted after adjusting for demographics, clinical characteristics, and socioeconomic factors (odds ratio 0.62, 95% confidence interval 0.50 to 0.75, p<0.001). In conclusion, among patients at an increased risk for sudden cardiac death, blacks were significantly less likely to receive ICDs than whites.
authors.affiliation: Duke University Medical Center, Durham, North Carolina, USA. thoma095@mc.duke.edu
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Thomas
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
authors.forename: Richard C
authors.initials: RC
authors.lastname: Kelsey
authors.forename: Heather
authors.initials: H
authors.lastname: Bush
authors.forename: Lynne
authors.initials: L
authors.lastname: Brosius
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: F Roosevelt
authors.initials: FR
authors.lastname: Gilliam
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D016757:Death, Sudden, Cardiac / Q000208:ethnology / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology / Q000401:mortality / Q000503:physiopathology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012042:Registries; D012959:Socioeconomic Factors; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000628:therapy*; D044465:White People / Q000706:statistics & numerical data