The incidence of ICD implantations declined significantly during the COVID-19 pandemic, according to a recent study published in Heart Rhythm. Although disparities by sex, race and ethnicity persisted during peak COVID, they did not worsen.

Saima Karim, DO, et al., used data from ACC's EP Device Implant Registry, including 239,014 patient implants from January 2016 to December 2022. Mean patient age was 64.9 years, 31% were women, 17% were Black and 7% Hispanic.

The authors note a substantial decrease in ICD implantation volume across all groups during the peak COVID period (March 2020 to May 2021). Weekly procedural volume was 749 in the prepandemic period, 389 during peak COVID, and then rose back up to 656 in the postpandemic period (p<0.001). This trend was mainly seen in primary prevention cases (–27%). Secondary prevention cases saw a much smaller decrease (–2%).

Analyses exploring differences by sex, race and ethnicity found comparable results. Men saw a 50% decrease in ICD implantation during peak COVID and women a 48% decrease, both rebounding in the postpandemic period. There was no significant sex-by-time interaction (p=0.79).

In addition, all race/ethnicity groups saw a similar decline of approximately 50% during peak COVID followed by a partial recovery. Race-by-time (p=0.47) and ethnicity-by-time (p=0.095) interactions were also not significant.

"Most ICDs were implanted in men and in white patients throughout the study period, consistent with historical trends...historical disparities by sex, race and ethnicity persisted without worsening," write the authors. "This stability across periods of severe resource scarcity suggests that pre-existing inequities in ICD use are not primarily driven by crisis-related rationing."