Do physicians' attitudes toward implantable cardioverter defibrillator therapy vary by patient age, gender, or race?

Published

Journal Article

BACKGROUND: Implantable cardioverter defibrillator (ICD) therapy improves survival of patients with systolic heart failure. We assessed whether physicians' recommendation for ICD therapy varies as a function of patient age, gender, race, and physician's specialty. METHODS: We surveyed a random sample (n = 9969) of U.S. physicians who are active members of the American College of Cardiology (ACC). We asked participants about their likelihood to recommend ICD therapy in 4 clinical scenarios that randomly varied patient age, gender, race, and ICD indication (guideline Class I, Class IIa, Class III, and Class I in a noncompliant patient). RESULTS: Responses were received from 1210 physicians (response rate 12%), of whom 1127 met the study inclusion criteria. Responders and nonresponders had similar demographics. In responding to hypothetical clinical scenarios, physicians were less likely to recommend an ICD to older patients (≥80 vs 50 years) (P < 0.01) but were unaffected by gender or race for all class indications. Compared with non-electrophysiologists (EPs), EPs were significantly more likely to recommend an ICD for a Class I indication (92.4% vs 81.4%; P < 0.01), but they were not more likely to offer an ICD for a Class III indication (0.4% vs 0.6%; P = 0.95). CONCLUSIONS: Based on survey responses, physicians were equally willing to offer an ICD to men and women and to whites and blacks, but were less likely to offer an ICD to an older patient even when indicated by practice guidelines. Electrophysiologists (EPs) more often adhered to practice guideline recommendations on ICD therapy compared with non-EPs.

Full Text

Duke Authors

Cited Authors

  • Al-Khatib, SM; Sanders, GD; O'Brien, SM; Matlock, D; Zimmer, LO; Masoudi, FA; Peterson, E

Published Date

  • January 2011

Published In

Volume / Issue

  • 16 / 1

Start / End Page

  • 77 - 84

PubMed ID

  • 21251138

Pubmed Central ID

  • 21251138

Electronic International Standard Serial Number (EISSN)

  • 1542-474X

International Standard Serial Number (ISSN)

  • 1082-720X

Digital Object Identifier (DOI)

  • 10.1111/j.1542-474x.2010.00412.x

Language

  • eng