Abstract 266: Ethnic Differences in Patient Characteristics but Not Implantable Cardioverter-Defibrillator (ICD) Utilization Rates for Primary Prevention of Sudden Cardiac Death (SCD)
Background: Underutilization of ICD's for primary prevention of SCD has been previously reported. Whether ethnic differences in utilization play a role in this is unclear.
Method: Retrospective chart review of consecutive heart failure (HF) pts in a suburban outpatient cardiology practice from Jan 2006-Dec 2010.
Results: Of the 2813 HF pts, 533 (19/%) had an ejection fraction of <35%, of whom 170 (32%) received an ICD device. Of the 533 pts, 23% were Caucasian (C), 67% African American (AA), 6% Southeast Asian (SEA), 3% East Indian (EI), 2% Hispanic (H). The mean age was 63+18 yrs, with AA (60 yrs) being youngest and C (72 yrs) the oldest (p<0.001). Mean EF (23%) ranged from 21% in EI to 25% in C (p<0.04). EI pts had more CAD (71%, p=<0.01) while AA pts had more hypertension (91%, p<0.001). No sig differences in smoking (16%) diabetes (39%), PVD (24%) hyperlipidemia (62%) or family history (37%) was seen. In those pts without an ICD (n=363) no documentation of a discussion was noted in 55% of charts. Documented pt refusal of an ICD trended higher in EI pts (29% p>0.057) Although males made up 62% of the group and were younger (62 vs 65 yrs,p<0.05) no gender differences in ICD implantation rates were seen. Pts were well treated for HF with no ethnic differences noted for use of diuretics (81%), ACEI/ARB (79%), beta-blockers (89%), digoxin (28%) warfarin 22% and aspirin (59%) Only statins were used more commonly in EI vs AA (71% vs 50%, p<0.05)
Conclusions: Our findings suggest that ICD's for primary prevention of SCD are underutilized in multiple ethnic groups. Lack of a documented discussion re ICD's is too common. There are significant ethnic differences in pt characteristics for HF etiology but not for HF pharmacotherapy utilization. Patient refusal rates for ICD's also vary among ethnic groups and require further evaluation to see if these differences can explain the observed underutilization of device therapy.
- Implantable cardioconvert defibrillator
- Healthcare delivery systems
- Heart failure
- Sudden cardiac death
- Ventricular defibrillation
- © 2011 by American Heart Association, Inc.