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Sex and Race/Ethnicity Differences in Implantable Cardioverter-Defibrillator Counseling and Use Among Patients Hospitalized With Heart Failure: Findings from the Get With The Guidelines-Heart Failure Program.

Publication ,  Journal Article
Hess, PL; Hernandez, AF; Bhatt, DL; Hellkamp, AS; Yancy, CW; Schwamm, LH; Peterson, ED; Schulte, PJ; Fonarow, GC; Al-Khatib, SM
Published in: Circulation
August 16, 2016

BACKGROUND: Previous studies have found that women and black patients eligible for a primary prevention implantable cardioverter-defibrillator (ICD) are less likely than men or white patients to receive one. METHODS: We performed an observational analysis of the Get With The Guidelines-Heart Failure Program from January 1, 2011, to March 21, 2014. Patients admitted with heart failure 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 from 236 sites, 4755 (22.6%) received predischarge ICD counseling. Women were counseled less frequently than men (19.3% versus 24.6%, P<0.001, adjusted odds ratio [OR], 0.84; 95% confidence interval [CI], 0.78-0.91). Racial and ethnic minorities were less likely to receive counseling than white patients (black 22.6%, Hispanic 18.6%, other race/ethnic group 14.4% versus white 24.3%, P<0.001 for each): adjusted OR versus white, 0.69; 95% CI, 0.63 to 0.76 for black patients; adjusted OR, 0.62; 95% CI, 0.55 to 0.70 for Hispanic patients; adjusted OR, 0.53; 95% CI, 0.43 to 0.65 for other patients. Among the 4755 counseled patients, 2977 (62.6%) received an ICD or had one planned for placement after hospital stay. Among those counseled, women and men were similarly likely to receive an ICD (adjusted OR, 1.13; 95% CI, 0.99-1.29). However, black (adjusted OR, 0.70; 95% CI, 0.56-0.88) and Hispanic patients (adjusted OR, 0.68; 95% CI, 0.46-1.01) were less likely to receive an ICD. CONCLUSIONS: Up to 4 of 5 hospitalized patients with heart failure eligible for ICD counseling did not receive it, particularly women and minority patients. Among counseled patients, ICD use differences by race and ethnicity persisted.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 16, 2016

Volume

134

Issue

7

Start / End Page

517 / 526

Location

United States

Related Subject Headings

  • Sex Characteristics
  • Racial Groups
  • Practice Guidelines as Topic
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
  • Female
  • Ethnicity
 

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Hess, P. L., Hernandez, A. F., Bhatt, D. L., Hellkamp, A. S., Yancy, C. W., Schwamm, L. H., … Al-Khatib, S. M. (2016). Sex and Race/Ethnicity Differences in Implantable Cardioverter-Defibrillator Counseling and Use Among Patients Hospitalized With Heart Failure: Findings from the Get With The Guidelines-Heart Failure Program. Circulation, 134(7), 517–526. https://doi.org/10.1161/CIRCULATIONAHA.115.021048
Hess, Paul L., Adrian F. Hernandez, Deepak L. Bhatt, Anne S. Hellkamp, Clyde W. Yancy, Lee H. Schwamm, Eric D. Peterson, Phillip J. Schulte, Gregg C. Fonarow, and Sana M. Al-Khatib. “Sex and Race/Ethnicity Differences in Implantable Cardioverter-Defibrillator Counseling and Use Among Patients Hospitalized With Heart Failure: Findings from the Get With The Guidelines-Heart Failure Program.Circulation 134, no. 7 (August 16, 2016): 517–26. https://doi.org/10.1161/CIRCULATIONAHA.115.021048.
Hess PL, Hernandez AF, Bhatt DL, Hellkamp AS, Yancy CW, Schwamm LH, Peterson ED, Schulte PJ, Fonarow GC, Al-Khatib SM. Sex and Race/Ethnicity Differences in Implantable Cardioverter-Defibrillator Counseling and Use Among Patients Hospitalized With Heart Failure: Findings from the Get With The Guidelines-Heart Failure Program. Circulation. 2016 Aug 16;134(7):517–526.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 16, 2016

Volume

134

Issue

7

Start / End Page

517 / 526

Location

United States

Related Subject Headings

  • Sex Characteristics
  • Racial Groups
  • Practice Guidelines as Topic
  • Middle Aged
  • Male
  • Humans
  • Hospitalization
  • Heart Failure
  • Female
  • Ethnicity