title: Primary prevention implantable cardioverter-defibrillators in older racial and ethnic minority patients.
abstract: BACKGROUND
  Racial and ethnic minorities are under-represented in clinical trials of primary prevention implantable cardioverter-defibrillators (ICDs). This analysis investigates the association between primary prevention ICDs and mortality among Medicare, racial/ethnic minority patients.
  
  
  RESULTS
  Data from Get With The Guidelines-Heart Failure Registry and National Cardiovascular Data Registry's ICD Registry were used to perform an adjusted comparative effectiveness analysis of primary prevention ICDs in Medicare, racial/ethnic minority patients (nonwhite race or Hispanic ethnicity). Mortality data were obtained from the Medicare denominator file. The relationship of ICD with survival was compared between minority and white non-Hispanic patients. Our analysis included 852 minority patients, 426 ICD and 426 matched non-ICD patients, and 2070 white non-Hispanic patients (1035 ICD and 1035 matched non-ICD patients). Median follow-up was 3.1 years. Median age was 73 years, and median ejection fraction was 23%. Adjusted 3-year mortality rates for minority ICD and non-ICD patients were 44.9% (95% confidence interval [CI], 44.2%-45.7%) and 54.3% (95% CI, 53.4%-55.1%), respectively (adjusted hazard ratio, 0.79; 95% CI, 0.63-0.98; P=0.034). White non-Hispanic patients receiving an ICD had lower adjusted 3-year mortality rates of 47.8% (95% CI, 47.3%-48.3%) compared with 57.3% (95% CI, 56.8%-57.9%) for those with no ICD (adjusted hazard ratio, 0.75; 95% CI, 0.67%-0.83%; P<0.0001). There was no significant interaction between race/ethnicity and lower mortality risk with ICD (P=0.70).
  
  
  CONCLUSIONS
  Primary prevention ICDs are associated with lower mortality in nonwhite and Hispanic patients, similar to that seen in white, non-Hispanic patients. These data support a similar approach to ICD patient selection, regardless of race or ethnicity.
authors.affiliation: From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.).
authors.forename: Sean D
authors.initials: SD
authors.lastname: Pokorney
authors.affiliation: From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.).
authors.forename: Anne S
authors.initials: AS
authors.lastname: Hellkamp
authors.affiliation: From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.).
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.affiliation: From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.).
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.affiliation: From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.).
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hammill
authors.affiliation: From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.).
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.).
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.).
authors.forename: Hussein R
authors.initials: HR
authors.lastname: Al-Khalidi
authors.affiliation: From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.).
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.affiliation: From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.).
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.affiliation: From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.). alkha001@mc.duke.edu.
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D057186:Comparative Effectiveness Research; D016757:Death, Sudden, Cardiac / Q000208:ethnology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005006:Ethnicity; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D006278:Medicare; D008913:Minority Groups; D011322:Primary Prevention / Q000295:instrumentation* / Q000379:methods; D044469:Racial Groups; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: continental population groups; death, sudden; defibrillators, implantable, ethnology; minority groups; primary prevention