Do physicians' attitudes toward implantable cardioverter defibrillator therapy vary by patient age, gender, or race?

Sana M. Al-Khatib, Gillian D. Sanders, Sean M. O'Brien, Daniel Matlock, Louise O. Zimmer, Frederick A. Masoudi, Eric Peterson

Research output: Contribution to journalArticlepeer-review

Abstract

Background:: Implantable cardioverter defibrillator (ICD) therapy improves survival of patients with systolic heart failure. We assessed whether physicians' recommendation for ICD therapy varies as a function of patient age, gender, race, and physician's specialty. Methods: We surveyed a random sample (n = 9969) of U.S. physicians who are active members of the American College of Cardiology (ACC). We asked participants about their likelihood to recommend ICD therapy in 4 clinical scenarios that randomly varied patient age, gender, race, and ICD indication (guideline Class I, Class IIa, Class III, and Class I in a noncompliant patient). Results: Responses were received from 1210 physicians (response rate 12%), of whom 1127 met the study inclusion criteria. Responders and nonresponders had similar demographics. In responding to hypothetical clinical scenarios, physicians were less likely to recommend an ICD to older patients (≥80 vs 50 years) (P < 0.01) but were unaffected by gender or race for all class indications. Compared with nonelectrophysiologists (EPs), EPs were significantly more likely to recommend an ICD for a Class I indication (92.4% vs 81.4%; P < 0.01), but they were not more likely to offer an ICD for a Class III indication (0.4% vs 0.6%; P = 0.95). Conclusions:: Based on survey responses, physicians were equally willing to offer an ICD to men and women and to whites and blacks, but were less likely to offer an ICD to an older patient even when indicated by practice guidelines. Electrophysiologists (EPs) more often adhered to practice guideline recommendations on ICD therapy compared with non-EPs.

Original languageEnglish (US)
Pages (from-to)77-84
Number of pages8
JournalAnnals of Noninvasive Electrocardiology
Volume16
Issue number1
DOIs
StatePublished - Jan 2011
Externally publishedYes

Keywords

  • health care survey
  • implantable cardioverter defibrillator
  • physician's attitudes
  • physician's practice patterns

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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