Sex and Race/Ethnicity Differences in ICD Counseling and Use

Study Questions:

Are women and minorities less likely to receive counseling about their primary prevention implantable cardioverter-defibrillator (ICD)?

Methods:

This was an 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, 4,755 (22.6%) received predischarge ICD counseling. Women were counseled less frequently than men (19% vs. 25%). The rates of documented counseling were 23% for black patients, 19% for Hispanic patients, 14% for other race/ethnic groups, and 24% for white patients. Among the 4,755 counseled patients, 63% received an ICD or had one planned as an outpatient. Among those counseled, women and men were similarly likely to receive an ICD, but black and Hispanic patients were less likely to receive an ICD.

Conclusions:

Up to four out of five 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.

Perspective:

Multiple prior reports have shown significant gaps in the implementation of guideline-endorsed life-prolonging and life quality-enhancing treatments. This report, however, brings it to a totally different level. If one accepts the proposition that a database requiring 223 fields for each HF admission is an accurate reflection of what happens during the hospitalization, then this report should cause a great deal of dismay. According to this analysis, only about one in five eligible HF patients received counseling about their candidacy for primary prevention ICD. Nota bene, one third of the surveyed hospitals are academic medical centers, presumably with well-developed subspecialty services. Are we really this incompetent?! Or is an old adage (with a small modification) still true? ‘If it is not in the chart (and the abstracter did not note it), it never happened.’

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

Keywords: African Americans, Arrhythmias, Cardiac, Counseling, Defibrillators, Implantable, Ethnic Groups, Healthcare Disparities, Heart Failure, Hispanic Americans, Minority Groups, Outpatients, Primary Prevention, Quality of Life


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