title: Women and minorities are less likely to receive an implantable cardioverter defibrillator for primary prevention of sudden cardiac death.
abstract: BACKGROUND
  Implantable cardioverter defibrillators (ICDs) improve survival in patients with depressed left ventricular ejection fraction (EF). We investigated whether women and minorities are as likely as white men to receive an ICD for primary prevention of sudden cardiac death.
  
  
  RESULTS
  We reviewed the electronic medical records of patients with cardiomyopathy by nuclear single-photon emission computed tomography imaging (EF ≤ 35%), who had no prior history of sustained ventricular arrhythmias. Clinical and demographic data were collected and the Charlson comorbidity index (CCI) was calculated for each patient. A total of 233 non-selected patients (age = 68 ± 12 years, 29% women, 21% black, EF 24 ± 6%, CCI 6.62 ± 2.9) were included in this analysis of whom 111 (48%) received an ICD. In univariate analysis, ICD recipients were more likely to be Caucasian men compared with black men or women from all races. After adjusting for race, gender, EF, and the CCI in a multivariate logistic regression model, women were 61% less likely than men [odds ratio (OR) = 0.39, 95% confidence interval (CI) 0.20-0.74, P= 0.004] and blacks were 72% less likely than whites (OR = 0.28, 95% CI 0.13-0.59, P= 0.001) to receive an ICD.
  
  
  CONCLUSIONS
  Even after adjusting for comorbid conditions, gender, and racial discrepancies in the implantation of ICDs for the primary prevention of sudden cardiac death exist. Further investigations into the root causes of these discrepancies are needed before any corrective measures can be adopted.
authors.affiliation: University of Pittsburgh Medical Center, 200 Lothrop Street, UPMC Presbyterian, Suite B-535, Pittsburgh, PA 15213-2582,  USA.
authors.forename: Ure
authors.initials: U
authors.lastname: Mezu
authors.forename: Iftikhar
authors.initials: I
authors.lastname: Ch
authors.forename: Indrani
authors.initials: I
authors.lastname: Halder
authors.forename: Barry
authors.initials: B
authors.lastname: London
authors.forename: Samir
authors.initials: S
authors.lastname: Saba
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data; D014930:Women