Published May 26, 2020
Stark disparities based on sex and race in the use of life-saving implantable cardioverter defibrillator (ICD) interventions suggest potential bias in care pathways implemented by electrophysiologists, according to results of a clinical trial presented by researchers at the Jacobs School of Medicine and Biomedical Sciences.
The study was presented May 5 as part of the Heart Rhythm Society’s HRS 2020 Science series, which was held online.
“When you consider the number of patients overall who are at risk of a cardiac arrest or have already survived a life-threatening cardiac event, the use of implantable cardioverter defibrillators is staggeringly low, and the disparities in use by sex and race are unmistakable,” says lead author Anne B. Curtis, MD, SUNY Distinguished Professor and Charles and Mary Bauer Professor and chair of medicine.
“Our hope is that these results will help physicians better identify patients who would benefit from guideline-directed device therapies and make sure that they receive this indicated and life-saving intervention,” says Curtis, president of UBMD Internal Medicine.
According to the results, only 41 percent of high-risk patients who have survived a life-threatening cardiac event, and therefore meet indications for ICDs, get them. Patients who could use ICD therapy for primary prevention of a cardiac arrest only get an ICD 8.3 percent of the time.
Since most ICDs are recommended and implanted by electrophysiologists, this study sought to examine real-world data to see how consultations with electrophysiologists impact disparities in ICD use by sex and race.
The trial included more than 159,000 patients (following screening procedures on electronic health records of 2.9 million patients with any cardiac disease, arrhythmia or syncope, from 47 U.S. health care systems) and included data on diagnoses, procedures, measures, prescriptions, labs and encounters.
These were de-identified electronic health record data where both patients and providers were anonymous.
The trial found that among the patients with a guideline directed device therapy indication, more men (54.7 percent) than women (51.2 percent) saw an electrophysiologist.
Among the 84,943 patients seen by an electrophysiologist, more men (28.1 percent) than women (23 percent) with an indication received a guideline directed device.
When looking at the same information by race, the majority of white patients (55.5 percent) saw an electrophysiologist, while only 46.9 percent of patients of other races, including Asian, black and Hispanic, saw an electrophysiologist.
Somewhat surprisingly, among patients seen by an electrophysiologist, slightly fewer white patients (25.9 percent) received guideline directed device therapy than patients of other races (27.9 percent).
The authors of the study call for quality improvement programs to be developed in health care systems. They hope to continue analyzing the data to discover additional insights on the use of ICDs.