Ethnic and racial disparities in cardiac resynchronization therapy

Heart Rhythm. 2009 Mar;6(3):325-31. doi: 10.1016/j.hrthm.2008.12.018. Epub 2008 Dec 13.

Abstract

Background: Racial/ethnic differences in the use of cardiac resynchronization therapy with defibrillator (CRT-D) may result from underprovision or overprovision relative to published guidelines.

Objective: The purpose of this study was to examine the National Cardiovascular Data Registry (NCDR) ICD Registry for ethnic/racial differences in use of CRT-D.

Methods: We studied white, black, and Hispanic patients who received either an implantable cardioverter-defibrillator (ICD) or CRT-D between January 2005 and April 2007. Two multivariate logistic regression models were fit with the following outcome variables: (1) receipt of either ICD or CRT-D and (2) receipt of CRT-D outside of published guidelines.

Results: Of 108,341 registry participants, 22,205 met inclusion criteria for the first analysis and 27,165 met criteria for the second analysis. Multivariate analysis indicated CRT-eligible black (odds ratio [OR] 0.84; 95% confidence interval [CI], 0.75-0.95; P <.004) and Hispanic (OR 0.83; 95% CI, 0.71-0.99; P <.033) patients were less likely to receive CRT-D than were white patients. A substantial proportion of patients received CRT-D outside of published guidelines, although black (OR 1.18; 95% CI, 1.02-1.36; P = .001) and Hispanic (OR 1.17; 95% CI, 1.02-1.36; P = .03) patients were more likely to meet all three eligibility criteria.

Conclusion: Black and Hispanic patients who were eligible for CRT-D were less likely to receive therapy compared with white patients. Conversely, in the context of widespread out-of-guideline use of CRT-D, black and Hispanic patients were more likely to meet established criteria. Our findings suggest systematic racial/ethnic differences in the treatment of patients with advanced heart failure.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans / statistics & numerical data
  • Aged
  • Cardiac Pacing, Artificial / statistics & numerical data*
  • Defibrillators, Implantable / statistics & numerical data*
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Guideline Adherence
  • Healthcare Disparities*
  • Heart Failure / ethnology*
  • Heart Failure / physiopathology
  • Heart Failure / therapy
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • United States