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

Paul L. Hess, Adrian F. Hernandez, Deepak L. Bhatt, Anne S. Hellkamp, Clyde W. Yancy, Lee H. Schwamm, Eric D. Peterson, Phillip Schulte, Gregg C. Fonarow, Sana M. Al-Khatib

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)517-526
Number of pages10
JournalCirculation
Volume134
Issue number7
DOIs
StatePublished - Aug 16 2016
Externally publishedYes

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Implantable Defibrillators
Counseling
Heart Failure
Guidelines
Odds Ratio
Confidence Intervals
Hispanic Americans
Primary Prevention
Ethnic Groups

Keywords

  • defibrillators, implantable
  • ethnic groups
  • healthcare disparities
  • heart failure
  • sex

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

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. / Hess, Paul L.; Hernandez, Adrian F.; Bhatt, Deepak L.; Hellkamp, Anne S.; Yancy, Clyde W.; Schwamm, Lee H.; Peterson, Eric D.; Schulte, Phillip; Fonarow, Gregg C.; Al-Khatib, Sana M.

In: Circulation, Vol. 134, No. 7, 16.08.2016, p. 517-526.

Research output: Contribution to journalArticle

Hess, Paul L. ; Hernandez, Adrian F. ; Bhatt, Deepak L. ; Hellkamp, Anne S. ; Yancy, Clyde W. ; Schwamm, Lee H. ; Peterson, Eric D. ; Schulte, Phillip ; Fonarow, Gregg C. ; Al-Khatib, Sana M. / 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. In: Circulation. 2016 ; Vol. 134, No. 7. pp. 517-526.
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title = "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",
abstract = "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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AU - Hernandez, Adrian F.

AU - Bhatt, Deepak L.

AU - Hellkamp, Anne S.

AU - Yancy, Clyde W.

AU - Schwamm, Lee H.

AU - Peterson, Eric D.

AU - Schulte, Phillip

AU - Fonarow, Gregg C.

AU - Al-Khatib, Sana M.

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N2 - 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.

AB - 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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