What is the Clinical Effectiveness of CRT and ICD Therapies in Minority Populations?

The use of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) has been shown to improve the clinical outcomes of select patients subject to heart failure with reduced ejection fraction. However, the racial/ethnic minority population has unfortunately been under-represented in trials to date, and consequently, significant gaps in quality of care exist for this demographic in contemporary practice.

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A new investigation, published Aug. 18 in the Journal of the American College of Cardiology led by Boback Ziaeian, MD, Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, CA, sought to determine the clinical effectiveness of CRT and ICD therapies in minority outpatients with heart failure with reduced ejection fraction, and found that there were no "meaningful differences in clinical effectiveness as a function of race/ethnicity for either ICD or CRT therapy, but additional research is warranted."

The study used data from the IMPROVE HF registry, which was analyzed by device status and race/ethnicity among guideline-eligible patients for mortality at 24 months. Among the 6,994 patients with heart failure with reduced ejection fraction who were treated at outpatient cardiology/multispecialty practices and were eligible for ICD/CRT-defibrillator, and the 1,023 patients eligible for CRT-pacemaker /CRT-defibrillator without crossover, results showed that the use of guideline-directed CRT and ICD therapy was associated with reduced 24-month mortality without significant interaction by racial/ethnic group.

Moving forward, the authors note that, "these findings may have important clinical implications and indicate that CRT-defibrillator and ICD therapies should be offered to all eligible patients with heart failure with reduced ejection fraction without modification based on race/ethnicity, pending further studies."

"This is an important study," writes Sean Pinney, MD, FACC, of the Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, NY, in a recent editorial. "Knowing that there is equal benefit between racial/ethnic groups only heightens the need to eliminate disparities in care delivery. The big question is how best to achieve this. Some potential solutions include integrating performance improvement programs into clinical practice, leveraging information technologies to provide clinical decision support tools, and broadening insurance coverage to all Americans to improve access to care."

Keywords: Ethnic Groups, Registries, Insurance Coverage, Cardiac Pacing, Artificial, Heart Failure, Death, Sudden, Cardiac, Defibrillators, Implantable, Cardiac Resynchronization Therapy

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