Primary Prevention Implantable Cardioverter-Defibrillators in Older Racial and Ethnic Minority Patients | Journal Scan

Study Questions:

Racial and ethnic minorities are under-represented in clinical trials of primary prevention implantable cardioverter-defibrillators (ICDs). What is the association between primary prevention ICDs and mortality among Medicare, racial/ethnic minority patients?

Methods:

Data from Get With The Guidelines-Heart Failure Registry and National Cardiovascular Data Registry’s ICD Registry were used to perform an adjusted comparative effectiveness analysis of primary prevention ICDs in Medicare, racial/ethnic minority patients (nonwhite race or Hispanic ethnicity). Mortality data were obtained from the Medicare denominator file. The relationship of ICD to survival was compared between minority and white non-Hispanic patients.

Results:

The analysis included 852 minority patients, 426 ICD and 426 matched non-ICD patients, and 2,070 white non-Hispanic patients (1,035 ICD and 1,035 matched non-ICD patients). Median follow-up was 3.1 years. Median age was 73 years, and median ejection fraction was 23%. Adjusted 3-year mortality rates for minority ICD and non-ICD patients were 44.9% and 54.3%, respectively (adjusted hazard ratio [HR], 0.79; p = 0.034). White non-Hispanic patients receiving an ICD had lower adjusted 3-year mortality rates of 47.8% compared with 57.3% for those with no ICD (adjusted HR, 0.75; p < 0.0001). There was no significant interaction between race/ethnicity and lower mortality risk with ICDs (p = 0.70).

Conclusions:

Primary prevention ICDs are associated with lower mortality in nonwhite and Hispanic patients, similar to that seen in white, non-Hispanic patients. These data support a similar approach to ICD patient selection, regardless of race or ethnicity.

Perspective:

Racial and ethnic minority patients were under-represented in clinical trials, which established efficacy of ICDs for primary prevention in cardiomyopathy patients. The minorities are at greater risk of heart failure, cardiac arrest, and sudden cardiac death relative to whites, but are still less likely than whites to receive ICDs. The current study suggests that benefits from primary prevention ICDs are no different across ethnic and racial populations, and that more should be done to address the disparity in access to ICDs.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Acute Heart Failure

Keywords: Defibrillators, Implantable, Cardiomyopathies, Heart Failure, Primary Prevention, Medicare, Hispanic Americans, Minority Groups, Registries


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