title: Sex and Race/Ethnicity Differences in Implantable Cardioverter-Defibrillator Counseling and Use Among Patients Hospitalized With Heart Failure: Findings from the Get With The Guidelines-Heart Failure Program.
abstract: Previous studies have found that women and black patients eligible for a primary prevention implantable cardioverter-defibrillator (ICD) are less likely than men or white patients to receive one.
  
  
  
  We performed an observational analysis of the Get With The Guidelines-Heart Failure Program from January 1, 2011, to March 21, 2014. Patients admitted with heart failure and an ejection fraction ≤35% without an ICD were included. Rates of ICD counseling among eligible patients and ICD receipt among counseled patients were examined by sex and race/ethnicity.
  
  
  
  Among 21 059 patients from 236 sites, 4755 (22.6%) received predischarge ICD counseling. Women were counseled less frequently than men (19.3% versus 24.6%, P<0.001, adjusted odds ratio [OR], 0.84; 95% confidence interval [CI], 0.78-0.91). Racial and ethnic minorities were less likely to receive counseling than white patients (black 22.6%, Hispanic 18.6%, other race/ethnic group 14.4% versus white 24.3%, P<0.001 for each): adjusted OR versus white, 0.69; 95% CI, 0.63 to 0.76 for black patients; adjusted OR, 0.62; 95% CI, 0.55 to 0.70 for Hispanic patients; adjusted OR, 0.53; 95% CI, 0.43 to 0.65 for other patients. Among the 4755 counseled patients, 2977 (62.6%) received an ICD or had one planned for placement after hospital stay. Among those counseled, women and men were similarly likely to receive an ICD (adjusted OR, 1.13; 95% CI, 0.99-1.29). However, black (adjusted OR, 0.70; 95% CI, 0.56-0.88) and Hispanic patients (adjusted OR, 0.68; 95% CI, 0.46-1.01) were less likely to receive an ICD.
  
  
  
  Up to 4 of 5 hospitalized patients with heart failure eligible for ICD counseling did not receive it, particularly women and minority patients. Among counseled patients, ICD use differences by race and ethnicity persisted.
authors: From VA Eastern Colorado Health Care System and Department of Medicine, University of Colorado School of Medicine, Denver (P.L.H.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., A.S.H., E.D.P., P.J.S., S.M.A.-K.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston (L.H.S.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles (G.C.F.). paul.hess@ucdenver.edu.
authors: Paul L
authors: PL
authors: Hess
authors: From VA Eastern Colorado Health Care System and Department of Medicine, University of Colorado School of Medicine, Denver (P.L.H.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., A.S.H., E.D.P., P.J.S., S.M.A.-K.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston (L.H.S.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles (G.C.F.).
authors: Adrian F
authors: AF
authors: Hernandez
authors: From VA Eastern Colorado Health Care System and Department of Medicine, University of Colorado School of Medicine, Denver (P.L.H.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., A.S.H., E.D.P., P.J.S., S.M.A.-K.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston (L.H.S.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles (G.C.F.).
authors: Deepak L
authors: DL
authors: Bhatt
authors: From VA Eastern Colorado Health Care System and Department of Medicine, University of Colorado School of Medicine, Denver (P.L.H.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., A.S.H., E.D.P., P.J.S., S.M.A.-K.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston (L.H.S.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles (G.C.F.).
authors: Anne S
authors: AS
authors: Hellkamp
authors: From VA Eastern Colorado Health Care System and Department of Medicine, University of Colorado School of Medicine, Denver (P.L.H.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., A.S.H., E.D.P., P.J.S., S.M.A.-K.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston (L.H.S.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles (G.C.F.).
authors: Clyde W
authors: CW
authors: Yancy
authors: From VA Eastern Colorado Health Care System and Department of Medicine, University of Colorado School of Medicine, Denver (P.L.H.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., A.S.H., E.D.P., P.J.S., S.M.A.-K.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston (L.H.S.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles (G.C.F.).
authors: Lee H
authors: LH
authors: Schwamm
authors: From VA Eastern Colorado Health Care System and Department of Medicine, University of Colorado School of Medicine, Denver (P.L.H.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., A.S.H., E.D.P., P.J.S., S.M.A.-K.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston (L.H.S.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles (G.C.F.).
authors: Eric D
authors: ED
authors: Peterson
authors: From VA Eastern Colorado Health Care System and Department of Medicine, University of Colorado School of Medicine, Denver (P.L.H.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., A.S.H., E.D.P., P.J.S., S.M.A.-K.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston (L.H.S.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles (G.C.F.).
authors: Phillip J
authors: PJ
authors: Schulte
authors: From VA Eastern Colorado Health Care System and Department of Medicine, University of Colorado School of Medicine, Denver (P.L.H.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., A.S.H., E.D.P., P.J.S., S.M.A.-K.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston (L.H.S.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles (G.C.F.).
authors: Gregg C
authors: GC
authors: Fonarow
authors: From VA Eastern Colorado Health Care System and Department of Medicine, University of Colorado School of Medicine, Denver (P.L.H.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (A.F.H., A.S.H., E.D.P., P.J.S., S.M.A.-K.); Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Department of Medicine, Northwestern University, Chicago, IL (C.W.Y.); Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston (L.H.S.); and Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, Los Angeles (G.C.F.).
authors: Sana M
authors: SM
authors: Al-Khatib
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003376:Counseling / Q000639:trends; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data* / Q000639:trends; D005006:Ethnicity; D005260:Female; D006333:Heart Failure / Q000208:ethnology* / Q000523:psychology / Q000628:therapy*; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D044469:Racial Groups / Q000208:ethnology*; D012727:Sex Characteristics
keywords: defibrillators, implantable; ethnic groups; healthcare disparities; heart failure; sex