Ethnic and racial disparities in cardiac resynchronization therapy.
BACKGROUND
Racial/ethnic differences in the use of cardiac resynchronization therapy with defibrillator (CRT-D) may result from underprovision or overprovision relative to published guidelines.


OBJECTIVE
The purpose of this study was to examine the National Cardiovascular Data Registry (NCDR) ICD Registry for ethnic/racial differences in use of CRT-D.


METHODS
We studied white, black, and Hispanic patients who received either an implantable cardioverter-defibrillator (ICD) or CRT-D between January 2005 and April 2007. Two multivariate logistic regression models were fit with the following outcome variables: (1) receipt of either ICD or CRT-D and (2) receipt of CRT-D outside of published guidelines.


RESULTS
Of 108,341 registry participants, 22,205 met inclusion criteria for the first analysis and 27,165 met criteria for the second analysis. Multivariate analysis indicated CRT-eligible black (odds ratio [OR] 0.84; 95% confidence interval [CI], 0.75-0.95; P <.004) and Hispanic (OR 0.83; 95% CI, 0.71-0.99; P <.033) patients were less likely to receive CRT-D than were white patients. A substantial proportion of patients received CRT-D outside of published guidelines, although black (OR 1.18; 95% CI, 1.02-1.36; P = .001) and Hispanic (OR 1.17; 95% CI, 1.02-1.36; P = .03) patients were more likely to meet all three eligibility criteria.


CONCLUSIONS
Black and Hispanic patients who were eligible for CRT-D were less likely to receive therapy compared with white patients. Conversely, in the context of widespread out-of-guideline use of CRT-D, black and Hispanic patients were more likely to meet established criteria. Our findings suggest systematic racial/ethnic differences in the treatment of patients with advanced heart failure.
Farmer
Steven A
SA
Department of Medicine, Cardiovascular Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. Steven.Farmer@uphs.upenn.edu
Kirkpatrick
James N
JN
Heidenreich
Paul A
PA
Curtis
Jeptha P
JP
Wang
Yongfei
Y
Groeneveld
Peter W
PW
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D054625:Healthcare Disparities; D006333:Heart Failure / Q000208:ethnology* / Q000503:physiopathology / Q000628:therapy; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D014481:United States; D044465:White People / Q000706:statistics & numerical data