Uninsured patients may be less likely to receive CRT therapy when indicated but more likely to receive optimal medical therapy at discharge, according to a study published Jan. 24 in the American Heart Journal.

Using data from ACC's ICD Registry, Imdad Ahmed, MD, FACC, et al., reviewed records of 286,556 patients younger than 65 years who received a new ICD implant to evaluate association between insurance status and guideline-directed CRT, as well as device type, complication rates and use of optimal medical therapy.

The mean age of patients was 53 years and 29% were female. Among all patients, 58% had private insurance, 20% had Medicaid, 13% had Medicare and 8.6% were uninsured.

Patients with private insurance and Medicare were more likely to receive CRT-D when indicated (79.6% and 78.5%, respectively) than those who were uninsured (76.7%) or on Medicaid (76.5%). Uninsured patients were more likely to receive a single-chamber ICD (49%) than those with private insurance (46.6%), Medicaid (47.8%) and Medicare (45.7%).

Complication rates were similar among those with private insurance (2.1%), Medicare (2.3%), no insurance (2.3%) and Medicaid (2.4%). Among patients receiving dual-chamber devices, adverse events were lower among those with private insurance vs. uninsured patients. Adverse event rates did not differ based on insurance status for single-chamber or CRT-devices. Uninsured patients were more likely to be receiving optimal medical therapy for heart failure at discharge after implantation (77.2%) vs. those with private insurance (75.7%), Medicaid (75.2%) and Medicare (73.5%).

According to the researchers, the findings "demonstrate that significant differences exist in ICD implant practice patterns based on insurance status." They note that uninsured patients are less likely than patients with private insurance or Medicare to receive CRT-D and are more likely to receive single-chamber devices. "Given prior data on the benefits of CRT and the underutilization of CRT in the uninsured demonstrated here, strategies to reduce disparities for the uninsured may improve outcomes," they conclude.

Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Middle Aged, Medically Uninsured, Medicaid, Patient Discharge, Medicare, Insurance Coverage, Heart Failure, National Cardiovascular Data Registries, Registries, ICD Registry

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