Trends in Use of Implantable Cardioverter Defibrillator Therapy Among Patients Hospitalized for Heart Failure: Have the Previously Observed Sex and Racial Disparities Changed Over Time?
Background—Prior studies have demonstrated low utilization of primary prevention implantable cardioverter defibrillators (ICDs), particularly among women and blacks. The degree to which the overall use of ICD therapy and disparities in use have changed is unclear.
Methods and Results—We examined 11,880 unique patients with a history of heart failure (HF) and left ventricular ejection fraction (LVEF) ≤35% who are ≥65 years old and enrolled in the Get With The Guidelines-Heart Failure (GWTG-HF) program from January 2005 through December 2009. We determined the rate of ICD use by year for the overall population and for sex and race groups. From 2005-2007, overall ICD use increased from 30.2% to 42.4% and then remained unchanged in 2008-2009. Adjusting for potential confounders, ICD use increased significantly in the overall study population during 2005-2007 (odds ratio [OR] 1.28; 95% confidence interval [CI], 1.11, 1.48 per year; P=0.0008) and in black women (OR 1.82; 95% CI, 1.28, 2.58 per year; P=0.0008), white women (OR 1.30; 95% CI, 1.06, 1.59 per year; P=0.010), black men (OR 1.54; 95% CI, 1.19, 1.99 per year; P=0.0009), and white men (OR 1.25; 95% CI, 1.06, 1.48 per year; P=0.0072). The increase in ICD use was greatest among blacks.
Conclusions—In the GWTG-HF quality improvement program, a significant increase in ICD therapy use was observed over time in all sex and race groups. The previously described racial disparities in ICD use were no longer present by the end of the study period; however, sex differences persisted.
- implantable cardioverter-defibrillator
- Get With the Guidelines-Heart Failure
- Received September 7, 2011.
- Accepted January 18, 2012.
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