Racial Disparity in the Utilization of Implantable-Cardioverter Defibrillators Among Patients With Prior Myocardial Infarction and an Ejection Fraction of ≤35%

Kevin L. Thomas, Sana M. Al-Khatib, Richard C. Kelsey, Heather Bush, Lynne Brosius, Eric J. Velazquez, Eric D. Peterson, F. Roosevelt Gilliam

Research output: Contribution to journalArticlepeer-review

Abstract

Age-adjusted sudden cardiac death rates are highest for black patients compared with other racial groups. The prophylactic implantation of an implantable cardioverter-defibrillator (ICD) provides a significant reduction in sudden cardiac death and overall mortality in patients after myocardial infarctions with significant left ventricular systolic dysfunction. The purpose of this study was to determine whether black patients with left ventricular systolic dysfunction were less likely than white patients to receive ICDs for the primary prevention of sudden cardiac death. Data from the National Registry to Advance Heart Health (ADVANCENT) were analyzed to determine which patients with histories of myocardial infarctions and ejection fractions ≤35% received ICDs for the primary prevention of sudden cardiac death. Multivariate logistic regression was used to evaluate the association of patients' race with ICD implantation. Overall, 7,830 patients were identified as eligible candidates for ICDs. Black patients (n = 660) were younger, more often women, had less education, had more co-morbidities, and had a lower mean ejection fraction compared with white patients (n = 7,170). More than 90% of the study population were insured, and approximately 88% of participants in the registry were enrolled by cardiologists. Blacks were significantly less likely than whites to receive ICDs (30% vs 41%, p <0.001). This difference in ICD use persisted after adjusting for demographics, clinical characteristics, and socioeconomic factors (odds ratio 0.62, 95% confidence interval 0.50 to 0.75, p <0.001). In conclusion, among patients at an increased risk for sudden cardiac death, blacks were significantly less likely to receive ICDs than whites.

Original languageEnglish (US)
Pages (from-to)924-929
Number of pages6
JournalAmerican Journal of Cardiology
Volume100
Issue number6
DOIs
StatePublished - Sep 15 2007
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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