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Adrian F. Hernandez, MD, MHS; Gregg C. Fonarow, MD; Li Liang, PhD; Sana M. Al-Khatib, MD, MHS; Lesley H. Curtis, PhD; Kenneth A. LaBresh, MD; Clyde W. Yancy, MD; Nancy M. Albert, PhD; Eric D. Peterson, MD, MPH

JAMA. 2007;298:1525-1532.

Context  Practice guidelines recommend implantable cardioverter-defibrillator (ICD) therapy for patients with heart failure and left ventricular ejection fraction of 30% or less. The influence of sex and race on ICD use among eligible patients is unknown.

Objective  To examine sex and racial differences in the use of ICD therapy.

Design, Setting, and Patients  Observational analysis of 13 034 patients admitted with heart failure and left ventricular ejection fraction of 30% or less and discharged alive from hospitals in the American Heart Association's Get With the Guidelines–Heart Failure quality-improvement program. Patients were treated between January 2005 and June 2007 at 217 participating hospitals.

Main Outcome Measures  Use of ICD therapy or planned ICD therapy at discharge.

Results  Among patients eligible for ICD therapy, 4615 (35.4%) had ICD therapy at discharge (1614 with new ICDs, 527 with planned ICDs, and 2474 with prior ICDs). ICDs were used in 375 of 1329 eligible black women (28.2%), 754 of 2531 white women (29.8%), 660 of 1977 black men (33.4%), and 2356 of 5403 white men (43.6%) (P < .001). After adjustment for patient characteristics and hospital factors, the adjusted odds of ICD use were 0.73 (95% confidence interval, 0.60-0.88) for black men, 0.62 (95% confidence interval, 0.56-0.68) for white women, and 0.56 (95% confidence interval, 0.44-0.71) for black women, compared with white men. The differences were not attributable to the proportions of women and black patients at participating hospitals or to differences in the reporting of left ventricular ejection fraction.

Conclusions  Less than 40% of potentially eligible patients hospitalized for heart failure received ICD therapy, and rates of use were lower among eligible women and black patients than among white men.

Author Affiliations: Duke Clinical Research Institute (Drs Hernandez, Liang, Al-Khatib, Curtis, and Peterson) and Department of Medicine (Drs Hernandez, Al-Khatib, Curtis, and Peterson), Duke University School of Medicine, Durham, North Carolina; University of California Los Angeles Medical Center (Dr Fonarow); Masspro, Waltham, Massachusetts (Dr LaBresh); Baylor Heart and Vascular Institute, Dallas, Texas (Dr Yancy); and Cleveland Clinic, Cleveland, Ohio (Dr Albert).

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RELATED LETTERS

Implantable Cardioverter-Defibrillators, Heart Failure, and Patient Characteristics
Nicholas J. Stamato
JAMA. 2008;299(3):285.
EXTRACT | FULL TEXT  

Implantable Cardioverter-Defibrillators, Heart Failure, and Patient Characteristics
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Implantable Cardioverter-Defibrillators, Heart Failure, and Patient Characteristics—Reply
Adrian F. Hernandez, Gregg C. Fonarow, and Eric D. Peterson
JAMA. 2008;299(3):286.
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