Abstract 3627: Racial and Ethnic Differences in Nationwide Utilization of Cardiac Resynchronization Therapy
Objective Prior studies have demonstrated racial/ethnic differences in access to innovative cardiovascular technologies. We hypothesized that racial and ethnic disparities in cardiac resynchronization therapy with defibrillator (CRT-D) implantation may exist since CRT-D is a relatively new technology requiring access to providers with substantial clinical expertise.
Methods We analyzed data recorded in the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) for implantable cardioverter defibrillators (ICDs) implanted from January, 2005- April, 2007. We selected white, black, or Hispanic patients with no prior CRT or ICD device who met established clinical criteria for CRT-D receipt: QRS duration >= 120 ms, LVEF <<26>35%, and class III or IV CHF. We fit a multivariable hierarchical logistic regression model with receipt of either a non-resynchronizing ICD or a CRT-D as the outcome variable. Independent variables included race/ethnicity, age, gender, cardiomyopathy etiology, duration of CHF, LVEF, blood pressure, QRS duration/morphology, prior coronary revascularization, atrial fibrillation, cerebrovascular disease, hypertension, diabetes, renal failure, and pulmonary disease.
Results Of 108,341 registry subjects, 31,434 met inclusion criteria, including 26,540 non-Hispanic whites (84%), 3,332 non-Hispanic blacks (11%), and 1,562 Hispanics (5%). In unadjusted analyses, whites (81%) received a CRT-D more frequently than blacks (77%) or Hispanics (75%) (p<0.001). Multivariable analysis indicated CRT-eligible black patients (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.73– 0.90; p<0.001) and Hispanic patients (OR 0.82, 95% CI 0.71– 0.94; p=0.005) remained less likely to receive a CRT-D than white patients even after adjustment for potential confounders.
Conclusions Among patients in a large, nationwide ICD registry who met clinical criteria for CRT, blacks and Hispanics were less likely to receive a CRT-D compared to non-Hispanic whites. These differences persisted despite extensive multivariate adjustment for demographic and clinical covariates. Differences in insurance status and/or health systems factors may further explain these differences and will be explored in future work.