Abstract 6: Inequitable Distribution of Implantable Cardioverter-Defibrillators in Ontario, Canada
BACKGROUND: Implantable cardioverter defibrillator (ICD) therapy reduces the risk of sudden death in patients with ischemic cardiomyopathy but their novelty and cost may represent barriers to utilization. We examined whether age, gender, place of residence, and socioeconomic status influence rates of ICD implantation for the primary prevention of death.
METHODS & RESULTS: This is a population-based retrospective cohort study involving the entire province of Ontario, Canada. Patients were eligible if they had survived a hospitalization for heart failure from January 1, 1993, to March 31, 2004 and previously sustained an acute coronary syndrome within 5 years. Patients with an existing ICD or a documented history of cardiac arrest were excluded, as were patients who died in hospital. We identified 48,426 patients hospitalized for heart failure who survived to hospital discharge. Of these, 440 received an ICD, with a gradual 30-fold increase in implantation rates over the study period (0.12% to 3.9%). ICD recipients were more likely to be male (OR=4.14; 95% CI [3.24–5.30]), younger than age 75(OR=3.19; 95% CI [2.57–3.96]), reside in a metropolitan area (OR=1.42; 95% CI [1.04–1.93]), and live in a higher socioeconomic neighborhood (OR=1.32; 95% CI [1.08–1.61]).
CONCLUSION: Among patients with heart failure and a previous acute coronary syndrome, ICD use is increasing in Ontario. However, the application of this technology is characterized by major sociodemographic inequities. The causes and consequences of the pronounced age and gender discrepancies, in particular, warrant further investigation.