Sex and Race/Ethnicity Differences in Implantable Cardioverter-Defibrillator Counseling and Use Among Patients Hospitalized With Heart Failure: Findings from the Get With The Guidelines-Heart Failure Program
Background—Prior studies found that women and black patients eligible for a primary prevention implantable defibrillator device (ICD) are less likely than men or white patients to receive one.
Methods—We performed an observational analysis of the Get With The Guidelines- Heart Failure (HF) Program from January 1, 2011, to March 21, 2014. Patients admitted with HF and an ejection fraction ≤ 35% without an ICD were included. Rates of ICD counseling among eligible patients and ICD receipt among counseled patients were examined by sex and race/ethnicity.
Results—Among 21 059 patients from 236 sites, 4755 (22.6%) received pre-discharge ICD counseling. Women were counseled less frequently than men (19.3% vs 24.6%, p <0.001, adjusted odds ratio (OR) 0.84, 95% confidence interval (CI) 0.78-0.91). Racial and ethnic minorities were less likely to receive counseling than white patients (black 22.6%, Hispanic 18.6%, other race/ethnic group 14.4% versus white 24.3%, p <0.001 for each), adjusted OR vs white 0.69, 95% CI 0.63-0.76 black; adjusted OR 0.62, 95% CI 0.55-0.70 Hispanic; adjusted OR 0.53, 95% CI 0.43-0.65 other). Among the 4755 counseled patients, 2977 (62.6%) received an ICD or had one planned for placement after hospital stay. Among those counseled, women and men were similarly likely to receive an ICD (adjusted OR 1.13, 95% CI 0.99-1.29). However, black (adjusted OR 0.70, 95% CI 0.56-0.88) and Hispanic patients (adjusted OR 0.68, 95% CI 0.46-1.01) were less likely to receive an ICD.
Conclusions—Up to 4 out of 5 hospitalized HF patients eligible for ICD counseling did not receive it, particularly women and minority patients. Among counseled patients, ICD use differences by race and ethnicity persisted.
- Received December 18, 2015.
- Revision received May 21, 2016.
- Accepted June 15, 2016.