Do physicians' attitudes toward implantable cardioverter defibrillator therapy vary by patient age, gender, or race?
BACKGROUND
Implantable cardioverter defibrillator (ICD) therapy improves survival of patients with systolic heart failure. We assessed whether physicians' recommendation for ICD therapy varies as a function of patient age, gender, race, and physician's specialty.


METHODS
We surveyed a random sample (n = 9969) of U.S. physicians who are active members of the American College of Cardiology (ACC). We asked participants about their likelihood to recommend ICD therapy in 4 clinical scenarios that randomly varied patient age, gender, race, and ICD indication (guideline Class I, Class IIa, Class III, and Class I in a noncompliant patient).


RESULTS
Responses were received from 1210 physicians (response rate 12%), of whom 1127 met the study inclusion criteria. Responders and nonresponders had similar demographics. In responding to hypothetical clinical scenarios, physicians were less likely to recommend an ICD to older patients (≥80 vs 50 years) (P < 0.01) but were unaffected by gender or race for all class indications. Compared with non-electrophysiologists (EPs), EPs were significantly more likely to recommend an ICD for a Class I indication (92.4% vs 81.4%; P < 0.01), but they were not more likely to offer an ICD for a Class III indication (0.4% vs 0.6%; P = 0.95).


CONCLUSIONS
Based on survey responses, physicians were equally willing to offer an ICD to men and women and to whites and blacks, but were less likely to offer an ICD to an older patient even when indicated by practice guidelines. Electrophysiologists (EPs) more often adhered to practice guideline recommendations on ICD therapy compared with non-EPs.
Duke Cardiovascular Center for Education and Research on Therapeutics, Duke Clinical Research Institute, Durham, NC, USA. alkha001@mc.duke.edu
Sana M
SM
Al-Khatib
Gillian D
GD
Sanders
Sean M
SM
O'Brien
Daniel
D
Matlock
Louise O
LO
Zimmer
Frederick A
FA
Masoudi
Eric
E
Peterson
D001291:Attitude of Health Personnel; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D010820:Physicians / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
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