Impact of race and gender on cardiac device implantations.
BACKGROUND
Pacemakers and implantable cardioverter-defibrillators (ICDs) are established therapies for life-threatening cardiac arrhythmias. Biventricular pacemakers (BiVP) can improve heart failure in selected patients as well.


OBJECTIVE
This study sought to investigate the impact of gender and race on rates of implantation of pacemakers and ICDs in patients with reduced left ventricular ejection fraction (LVEF).


METHODS
Data were obtained from ADVANCENT, a prospective multicenter registry enrolling patients with LVEF < or = 40% between June 2003 and November 2004. a total of 26,264 patients from 106 us centers were enrolled. the mean age was 66.4 years; 71.5% were male and 81.9% were white; 10,394 subjects (39.6%) had devices implanted.


RESULTS
The overall rate of device implantation was higher in white subjects compared with nonwhite subjects (41.1% vs 32.5%, P <.0001). This was also true for the rates of implantation of all types of ICDs (28.6% vs 23.9%, P <.0001) and BiVP (11.2% vs 7.7%, P <.0001). After adjusting for age, gender, LVEF, New York Heart Association class, coronary artery disease, QRS duration, comorbidities, type of referring physician, and insurance type, nonwhite race remained an independent negative predictor of implantation of any device (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.791 to 0.927), and any ICD (OR 0.88, 95% CI 0.817 to 0.964). Female gender was also independently associated with decreased implantation of any device (OR 0.70, 95% CI 0.66 to 0.76), and any ICD (OR 0.60, 95% CI 0.55 to 0.64).


CONCLUSIONS
In this large cohort with reduced LVEF, minorities and women were significantly less likely to receive device implants. These findings were most pronounced in nonwhite women, and could not be explained by disparities in demographic or clinical characteristics.
El-Chami
Mikhael F
MF
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Birmingham, Alabama, USA. melcham@emory.edu
Hanna
Ibrahim R
IR
Bush
Heather
H
Langberg
Jonathan J
JJ
D000368:Aged; D002304:Cardiac Pacing, Artificial; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D005783:Gender Identity; D054624:Health Status Disparities; D006333:Heart Failure / Q000208:ethnology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D044469:Racial Groups; D012042:Registries; D012737:Sex Factors; D013318:Stroke Volume; D013599:Systole