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Seo J, Alhuarrat MAD, Krishnan S, Saralidze T, Lim H, Chen B, Flomenbaum D, Naser A, Kharawala A, Apple SJ, Ferrick N, Chudow J, Di Biase L, Fisher JD, Krumerman A, Ferrick KJ. Utilization of the remote monitoring of cardiac implantable electronic devices in a diverse demographic cohort: Insights from a single-center observation. Pacing Clin Electrophysiol 2024; 47:185-194. [PMID: 38010836 DOI: 10.1111/pace.14883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/29/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Despite its clinical benefits, patient compliance to remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) varies and remains under-studied in diverse populations. OBJECTIVE We sought to evaluate RM compliance, clinical outcomes, and identify demographic and socioeconomic factors affecting RM in a diverse urban population in New York. METHODS This retrospective cohort study included patients enrolled in CIED RM at Montefiore Medical Center between December 2017 and May 2022. RM compliance was defined as the percentage of days compliant to RM transmission divided by the total prescribed days of RM. Patients were censored when they were lost to follow-up or at the time of death. The cohorts were categorized into low (≤30%), intermediate (31-69%), and high (≥70%) RM compliance groups. Statistical analyses were conducted accordingly. RESULTS Among 853 patients, median RM compliance was 55%. Age inversely affected compliance (p < .001), and high compliance was associated with guideline-directed medical therapy (GDMT) usage and implantable cardioverter defibrillator (ICD)/cardiac resynchronization defibrillator (CRTD) devices. The low-compliance group had a higher mortality rate and fewer regular clinic visits (p < .001) than high-compliance group. Socioeconomic factors did not significantly impact compliance, while Asians showed higher compliance compared with Whites (OR 3.67; 95% CI 1.08-12.43; p = .04). Technical issues were the main reason for non-compliance. CONCLUSION We observed suboptimal compliance to RM, which occurred most frequently in older patients. Clinic visit compliance, optimal medical therapy, and lower mortality were associated with higher compliance, whereas insufficient understanding of RM usage was the chief barrier to compliance.
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Affiliation(s)
- Jiyoung Seo
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Suraj Krishnan
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tinatin Saralidze
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hyomin Lim
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Brett Chen
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David Flomenbaum
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Ahmad Naser
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Amrin Kharawala
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Samuel J Apple
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Neal Ferrick
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jay Chudow
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - John D Fisher
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrew Krumerman
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kevin J Ferrick
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Tertulien T, Bush K, Jackson LR, Essien UR, Eberly L. Racial and Ethnic Disparities in Implantable Cardioverter-Defibrillator Utilization: A Contemporary Review. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2023; 25:771-791. [PMID: 38873495 PMCID: PMC11172403 DOI: 10.1007/s11936-023-01025-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 06/15/2024]
Abstract
Purpose of review Sudden cardiac arrest is associated with high morbidity and mortality. Despite having a disproportionate burden of sudden cardiac death (SCD), rates of primary and secondary prevention of SCD with implantable cardioverter-defibrillator (ICD) therapy are lower among eligible racially minoritized patients. This review highlights the racial and ethnic disparities in ICD utilization, associated barriers to ICD care, and proposed interventions to improve equitable ICD uptake. Recent findings Racially minoritized populations are disproportionately eligible for ICD therapy but are less likely to see cardiac specialists, be counseled on ICD therapy, and ultimately undergo ICD implantation, fueling disparate outcomes. Racial disparities in ICD utilization are multifactorial, with contributions at the patient, provider, health system, and structural/societal level. Summary Racial and ethnic disparities have been demonstrated in preventing SCD with ICD use. Proposed strategies to mitigate these disparities must prioritize care delivery and access to care for racially minoritized patients, increase the diversification of clinical and implementation trial participants and the healthcare workforce, and center reparative justice frameworks to rectify a long history of racial injustice.
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Affiliation(s)
- Tarryn Tertulien
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kelvin Bush
- Division of Cardiology, San Antonio Military Medical Center, Fort Sam Houston, TX, USA
| | - Larry R. Jackson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Utibe R. Essien
- Division of General Internal Medicine – Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Lauren Eberly
- Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Lopez JL, Duarte G, Taylor CN, Ibrahim NE. Achieving Health Equity in the Care of Patients with Heart Failure. Curr Cardiol Rep 2023; 25:1769-1781. [PMID: 37975970 DOI: 10.1007/s11886-023-01994-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW To discuss the prevailing racial and ethnic disparities in heart failure (HF) care by identifying barriers to equitable care and proposing solutions for achieving equitable outcomes. RECENT FINDINGS Throughout the entire spectrum of HF care, from prevention to implementation of guideline-directed medical therapy and advanced interventions, racial and ethnic disparities exist. Factors such as differential distribution of risk factors, poor access to care, inadequate representation in clinical trials, and discrimination from healthcare clinicians, among others, contribute to these disparities. Recent data suggests that despite improvements, disparities prevail in several aspects of HF care, hindering our progress towards equity in HF care. This review highlights the urgent need to address racial and ethnic disparities in HF care, emphasizing the importance of a multifaceted approach involving policy changes, quality improvement strategies, targeted interventions, and intentional community engagement. Our proposed framework was derived from existing research and emphasizes integrating equity into routine quality improvement efforts, tailoring interventions to specific populations, and advocating for policy transformation. By acknowledging these disparities, implementing evidence-based strategies, and fostering collaborative efforts, the HF community can strive to reduce disparities and achieve equity in HF care.
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Affiliation(s)
- Jose L Lopez
- Division of Cardiovascular Disease, JFK Hospital, University of Miami Miller School of Medicine, Atlantis, FL, USA
| | - Gustavo Duarte
- Division of Cardiology, Cleveland Clinic Florida, Weston, FL, USA
| | - Christy N Taylor
- Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York City, NY, USA
| | - Nasrien E Ibrahim
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA.
- The Equity in Heart Transplant Project, Inc, Boston, MA, USA.
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Younis A, Ali S, Hsich E, Goldenberg I, McNitt S, Polonsky B, Aktas MK, Kutyifa V, Wazni OM, Zareba W, Goldenberg I. Arrhythmia and Survival Outcomes Among Black Patients and White Patients With a Primary Prevention Defibrillator. Circulation 2023; 148:241-252. [PMID: 37459413 DOI: 10.1161/circulationaha.123.065367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Black Americans have a higher risk of nonischemic cardiomyopathy (NICM) than White Americans. We aimed to evaluate differences in the risk of tachyarrhythmias among patients with an implantable cardioverter-defibrillator (ICD). METHODS The study population comprised 3895 ICD recipients in the United States enrolled in primary prevention ICD trials. Outcome measures included ventricular tachyarrhythmia (VTA), atrial tachyarrhythmia (ATA), ICD therapies, VTA burden (using Andersen-Gill recurrent event analysis), death, and the predicted benefit of the ICD. All events were adjudicated blindly. Outcomes were compared between self-reported Black patients versus White patients with cardiomyopathy (ischemic and NICM). RESULTS Black patients were more likely to be female (35% versus 22%) and younger (57±12 versus 62±12 years) with a higher frequency of comorbidities. In NICM, Black patients had a higher rate of first VTA, fast VTA, ATA, and appropriate and inappropriate ICD therapy (VTA ≥170 bpm, 32% versus 20%; VTA ≥200 bpm, 22% versus 14%; ATA, 25% versus 12%; appropriate therapy, 30% versus 20%; and inappropriate therapy, 25% versus 11%; P<0.001 for all). Multivariable analysis showed that Black patients with NICM experienced a higher risk of all types of arrhythmia or ICD therapy (VTA ≥170 bpm, hazard ratio [HR] 1.71; VTA ≥200 bpm, HR 1.58; ATA, HR 1.87; appropriate therapy, HR 1.62; inappropriate therapy, HR 1.86; P≤0.01 for all), higher burden of tachyarrhythmias or therapies (VTA, HR 1.84; appropriate therapy, HR 1.84; P<0.001 for both), and a higher risk of death (HR 1.92; P=0.014). In contrast, in ischemic cardiomyopathy, the risk of all types of tachyarrhythmia, ICD therapy, or death was similar between Black patients and White patients. Both Black patients and White patients derived a significant and similar benefit from ICD implantation. CONCLUSIONS Among patients with NICM with an ICD for primary prevention, Black patients compared with White patients had a high risk and burden of VTA, ATA, and ICD therapies with a lower survival rate. Nevertheless, the overall benefit of the ICD was maintained and was similar to that of White patients.
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MESH Headings
- Humans
- Female
- United States/epidemiology
- Male
- White
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Risk Factors
- Arrhythmias, Cardiac
- Cardiomyopathies
- Defibrillators, Implantable
- Tachycardia, Ventricular/therapy
- Tachycardia, Ventricular/epidemiology
- Primary Prevention
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Affiliation(s)
- Arwa Younis
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, NY (A.Y., S.A., S.M., B.P., M.K.A., V.K., W.Z., Ilan Goldenberg)
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (A.Y., E.H., O.M.W.)
| | - Sanah Ali
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, NY (A.Y., S.A., S.M., B.P., M.K.A., V.K., W.Z., Ilan Goldenberg)
| | - Eileen Hsich
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (A.Y., E.H., O.M.W.)
| | - Ido Goldenberg
- Department of Internal Medicine, Rochester General Hospital, NY (Ido Goldenberg)
| | - Scott McNitt
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, NY (A.Y., S.A., S.M., B.P., M.K.A., V.K., W.Z., Ilan Goldenberg)
| | - Bronislava Polonsky
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, NY (A.Y., S.A., S.M., B.P., M.K.A., V.K., W.Z., Ilan Goldenberg)
| | - Mehmet K Aktas
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, NY (A.Y., S.A., S.M., B.P., M.K.A., V.K., W.Z., Ilan Goldenberg)
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, NY (A.Y., S.A., S.M., B.P., M.K.A., V.K., W.Z., Ilan Goldenberg)
| | - Oussama M Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (A.Y., E.H., O.M.W.)
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, NY (A.Y., S.A., S.M., B.P., M.K.A., V.K., W.Z., Ilan Goldenberg)
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, NY (A.Y., S.A., S.M., B.P., M.K.A., V.K., W.Z., Ilan Goldenberg)
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Al-Khatib SM, Thomas KL. Advancing Equity in Sudden Cardiac Death Prevention: Beware of Making Assumptions About the Effectiveness of Primary Prevention Implantable Cardioverter-Defibrillators in Black Patients. Circulation 2023; 148:253-255. [PMID: 37459416 DOI: 10.1161/circulationaha.123.065723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Sana M Al-Khatib
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Kevin L Thomas
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
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Vij N, Bingham J, Chen A, Irwin C, Leber C, Schwartz K, Schmidt K. Race and Sex Disparities in Lower Extremity Total Joint Arthroplasty: A Retrospective Database Study. Cureus 2023; 15:e42485. [PMID: 37637575 PMCID: PMC10452050 DOI: 10.7759/cureus.42485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION Total joint arthroplasty (TJA) is successful in improving health-related quality of life. However, outcomes vary in the literature due to modifiable and non-modifiable factors. Modifiable factors consist of body mass index (BMI), nutrition, and tobacco use. Non-modifiable risk factors include age, race, sex, and socioeconomic status. Prior literature has focused on racial disparities in terms of the utilization of lower extremity arthroplasty. The purpose of this study is to determine the effect of race and sex on the in-hospital complication rate, length of stay, and charges associated with primary TJA. METHODS This retrospective cohort utilized complex survey data from the National Inpatient Sample (NIS) between 2016 and 2019. The use of the International Classification of Disease-10 Procedure Codes (ICD-10 PCS) for right hip, left hip, right knee, and left knee TJA yielded a preliminary total of 2,660,280 patients. The exclusion criteria were bilateral arthroplasty and concomitant unilateral hip and knee arthritis. Major complications were defined as acute myocardial infarction, cardiac arrest, pulmonary embolism, adult respiratory distress syndrome, stroke, shock, and septicemia. Odds ratio (OR) and beta coefficients were adjusted for age, sex, primary payer, hospital region, hospital teaching status, and year. Total charges were adjusted for inflation using the Consumer Price Index data reported by the US Bureau of Labor Statistics. RESULTS A total of 2,589,510 patients met our inclusion criteria; 87.6%, 5.9%, 4.8%, 1.4%, and 0.3% of people were 'White', 'Black', 'Hispanic', 'Asian, or Pacific Islander', and 'Native American', as defined by the National (Nationwide) Inpatient Sample (NIS) Variable 'RACE'. Black individuals experienced a significantly greater major complication rate compared to White individuals (0.87% vs. 0.74%, OR 1.25, p-value = 0.0004). Black and Hispanic individuals experienced a significantly greater minor complication rate compared to White individuals (6.39% vs. 4.12%, odds ratio (OR) 1.61, p-value < 0.0001; 4.68% vs. 4.12%, OR 1.17, p-value < 0.0001). Black, Hispanic, Asian or Pacific Islander, and Native American individuals stayed, on average, 0.33, 0.19, 0.19, and 0.25 days longer than White individuals (2.78, 2.54, 2.55, 2.56 vs. 2.37 days, p<0.0001). None of these statistically significant differences exceeded the established minimal clinically important difference of two days. Black, Hispanic, and Asian or Pacific Islander patients were charged $5,751, $18,656, and $12,119 more than White patients ($72,122, $85,027, $78,490, and $59,297 vs. $66,371, p ≤ 0.0165). Native American patients were charged $7,074 less than White patients ($59,297 vs. $66,371, p < 0.0001). CONCLUSIONS Black and Hispanic TJA patients may have higher complication rates than White TJA patients. The differences in length of stay between race groups may not affect outcomes. Hispanic patients received significantly more charges than White patients, and Native American patients received significantly fewer charges than White patients after controlling for non-modifiable risk factors. Addressing the charge disparities may reduce the total national cost burden associated with TJA. The present study highlights the need for further studies on healthcare outcomes related to race and sex.
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Affiliation(s)
- Neeraj Vij
- Department of Orthopaedic Surgery, University of Kansas School of Medicine - Wichita, Wichita, USA
| | - Joshua Bingham
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, USA
| | - Antonia Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, USA
| | - Chase Irwin
- Department of Biostatistics, University of Arizona College of Medicine - Phoenix, Phoenix, USA
| | - Christian Leber
- Department of Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, USA
| | - Kendall Schwartz
- Department of Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, USA
| | - Kenneth Schmidt
- Department of Orthopaedic Surgery, OrthoArizona, Phoenix, USA
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Ilonze O, Free K, Shinnerl A, Lewsey S, Breathett K. Racial, Ethnic, and Gender Disparities in Valvular Heart Failure Management. Heart Fail Clin 2023; 19:379-390. [PMID: 37230651 PMCID: PMC10614031 DOI: 10.1016/j.hfc.2023.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Racial, ethnic, and gender disparities are present in the diagnosis and management of valvular heart disease. The prevalence of valvular heart disease varies by race, ethnicity, and gender, but diagnostic evaluations are not equitable across the groups, which makes the true prevalence less clear. The delivery of evidence-based treatments for valvular heart disease is not equitable. This article focuses on the epidemiology of valvular heart diseases associated with heart failure and the related disparities in treatment, with a focus on how to improve delivery of nonpharmacological and pharmacological treatments.
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Affiliation(s)
- Onyedika Ilonze
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA
| | - Kendall Free
- Department of Biofunction Research, Tokyo Medical and Dental University, 2 Chome-3-10 Kanda Surugadai, Chiyoda City, Tokyo 101-0062, Japan
| | - Alexander Shinnerl
- College of Medicine, Indiana University, 340 West 10th Street, Indianapolis, IN 46202, USA
| | - Sabra Lewsey
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 601 North Caroline Street, 7th Floor, Baltimore, MD 21287, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, 1800 North Capitol Avenue, Indianapolis, IN 46202, USA.
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Younis A, Ali S, Hsich E, Goldenberg I, McNitt S, Polonsky B, Aktas MK, Kutyifa V, Wazni OM, Zareba W, Goldenberg I. Arrhythmia and Survival Outcomes among Black and White Patients with a Primary Prevention Defibrillator. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.01.23289362. [PMID: 37205384 PMCID: PMC10187345 DOI: 10.1101/2023.05.01.23289362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Background Black Americans have a higher risk of non-ischemic cardiomyopathy (NICM) than White Americans. We aimed to evaluate racial disparities in the risk of tachyarrhythmias among patients with an implantable cardioverter defibrillator (ICD). Methods The study population comprised 3,895 ICD recipients enrolled in the U.S. in primary prevention ICD trials. Outcome measures included first and recurrent ventricular tachy-arrhythmia (VTA) and atrial tachyarrhythmia (ATA), derived from adjudicated device data, and death. Outcomes were compared between self-reported Black vs. White patients with a cardiomyopathy (ischemic [ICM] and NICM). Results Black patients were more likely to be female (35% vs 22%) and younger (57±12 vs 62±12) with a higher frequency of comorbidities. Blacks patients with NICM compared with Whites patients had a higher rate of first VTA, fast VTA, ATA, appropriate-, and inappropriate-ICD-therapy (VTA≥170bpm: 32% vs. 20%; VTA≥200bpm: 22% vs. 14%; ATA: 25% vs. 12%; appropriate 30% vs 20%; and inappropriate: 25% vs. 11%; p<0.001 for all). Multivariable analysis showed that Black patients with NICM experienced a higher risk of all types of arrhythmia/ICD-therapy (VTA≥170bpm: HR=1.69; VTA≥200bpm: HR=1.58; ATA: HR=1.87; appropriate: HR=1.62; and inappropriate: HR=1.86; p≤0.01 for all), higher burden of VTA, ATA, ICD therapies, and a higher risk of death (HR=1.86; p=0.014). In contrast, in ICM, the risk of all types of tachyarrhythmia, ICD therapy, or death was similar between Black and White patients. Conclusions Among NICM patients with an ICD for primary prevention, Black compared with White patients had a high risk and burden of VTA, ATA, and ICD therapies. Clinical Perspective What Is New?: Black patients have a higher risk of developing non-ischemic cardiomyopathy (NICM) but are under-represented in clinical trials of implantable cardioverter defibrillators (ICD). Therefore, data on disparities in the presentation and outcomes in this population are limited.This analysis represents the largest group of self-identified Black patients implanted in the U.S. with an ICD for primary prevention with adjudication of all arrhythmic events.What Are the Clinical Implications?: In patients with a NICM, self-identified Black compared to White patients experienced an increased incidence and burden of ventricular tachyarrhythmia, atrial tachyarrhythmia, and ICD therapies. These differenced were not observed in Black vs White patients with ischemic cardiomyopathy (ICM).Although Black patients with NICM were implanted at a significantly younger age (57±12 vs 62±12 years), they experienced a 2-fold higher rate of all-cause mortality during a mean follow up of 3 years compared with White patients.These findings highlight the need for early intervention with an ICD, careful monitoring, and intensification of heart failure and antiarrhythmic therapies among Black patients with NICM.
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Thomas KL, Al-Khatib SM, Kosinski AS, Sears SF, Allen LaPointe NM, Jackson LR, Matlock DD, Haithcock D, Colley BJ, Hirsh DS, Peterson ED. Facilitating Shared Decision Making Among Black Patients at Risk for Sudden Cardiac Arrest : A Randomized Clinical Trial. Ann Intern Med 2023; 176:615-623. [PMID: 37011387 PMCID: PMC10354526 DOI: 10.7326/m22-2934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Racial disparities in implantable cardioverter-defibrillator (ICD) implantation are multifactorial and are partly explained by higher refusal rates. OBJECTIVE To assess the effectiveness of a video decision support tool for Black patients eligible for an ICD. DESIGN Multicenter, randomized clinical trial conducted between September 2016 and April 2020. (ClinicalTrials.gov: NCT02819973). SETTING Fourteen academic and community-based electrophysiology clinics in the United States. PARTICIPANTS Black adults with heart failure who were eligible for a primary prevention ICD. INTERVENTION An encounter-based video decision support tool or usual care. MEASUREMENTS The primary outcome was the decision regarding ICD implantation. Additional outcomes included patient knowledge, decisional conflict, ICD implantation within 90 days, the effect of racial concordance on outcomes, and the time patients spent with clinicians. RESULTS Of the 330 randomly assigned patients, 311 contributed data for the primary outcome. Among those randomly assigned to the video group, assent to ICD implantation was 58.6% compared with 59.4% in the usual care group (difference, -0.8 percentage point [95% CI, -13.2 to 11.1 percentage points]). Compared with usual care, participants in the video group had a higher mean knowledge score (difference, 0.7 [CI, 0.2 to 1.1]) and a similar decisional conflict score (difference, -2.6 [CI, -5.7 to 0.4]). The ICD implantation rate within 90 days was 65.7%, with no differences by intervention. Participants randomly assigned to the video group spent less time with their clinician than those in the usual care group (mean, 22.1 vs. 27.0 minutes; difference, -4.9 minutes [CI, -9.4 to -0.3 minutes]). Racial concordance between video and study participants did not affect study outcomes. LIMITATION The Centers for Medicare & Medicaid Services implemented a requirement for shared decision making for ICD implantation during the study. CONCLUSION A video-based decision support tool increased patient knowledge but did not increase assent to ICD implantation. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute.
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Affiliation(s)
- Kevin L Thomas
- Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina (K.L.T., S.M.A.)
| | - Sana M Al-Khatib
- Department of Medicine and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina (K.L.T., S.M.A.)
| | | | - Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, North Carolina (S.F.S.)
| | - Nancy M Allen LaPointe
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina (N.M.A.L.)
| | - Larry R Jackson
- Department of Medicine, Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina (L.R.J.)
| | - Daniel D Matlock
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado (D.D.M.)
| | | | | | - David S Hirsh
- Department of Medicine, Emory University, Atlanta, Georgia (D.S.H.)
| | - Eric D Peterson
- Department of Medicine, University of Texas Southwestern, Dallas, Texas (E.D.P.)
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Lehmann HI, Sharma K, Bhatia R, Mills T, Lang J, Li G, Andrews C, Cullivan J, Singh J, Mela T. Real-World Disparities in Remote Follow-Up of Cardiac Implantable Electronic Devices and Impact of the COVID-19 Pandemic: A Single-Center Experience. J Am Heart Assoc 2023; 12:e027500. [PMID: 36688364 PMCID: PMC9973665 DOI: 10.1161/jaha.122.027500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/16/2022] [Indexed: 01/24/2023]
Abstract
Background Remote monitoring (RM) of cardiac implantable electronic devices has been shown to improve cardiovascular morbidity and mortality. To date, no studies have investigated disparities in use and delivery of RM. This study was performed to investigate if racial and socioeconomic disparities are present in cardiac implantable electronic device RM. Methods and Results This was a retrospective observational cohort study at a single tertiary care center in the United States. Patients who received a newly implanted cardiac implantable electronic device or device upgrade between January 2017 and December 2020 were included. Patients were classified as RM positive (RM+) when they underwent at least ≥2 remote interrogations per year during follow-up. Of all eligible patients, 2520 patients were included, and 34% were women. The mean follow-up was 25 months. Mean age was 71±14 years. Pacemakers constituted 66% of implanted devices, whereas 26% were implantable cardioverter-defibrillators, and 8% were cardiac resynchronization therapy with implantable cardioverter-defibrillators. Most patients (83%) were of European American ancestry. During follow-up, 66% of patients were classified as RM+. Patients who were younger, European American, college-educated, lived in a county with higher median household income, and were active on the hospital's patient portals were more frequently RM+. In an adjusted regression model, RM+ remained associated with the use of the online patient portal (odds ratio [OR], 2.889 [95% CI, 2.387-3.497]), presence of an implantable cardioverter-defibrillator (OR, 1.489 [95% CI, 1.207-1.835]), advanced college degree (OR, 1.244 [95% CI, 1.014-1.527]), and lastly with European American ancestry (P<0.05). During the years of the COVID-19 pandemic, the number of RM+ patients increased, whereas the association with ancestry and ethnicity decreased. Conclusions Despite being offered to all patients at implantation, significant disparities were present in cardiovascular implantable electronic device RM in this cohort. Disparities were partly reversed during COVID-19. Further studies are needed to examine health center- and patient-specific factors to overcome these barriers, and to facilitate equal opportunities to participate in RM.
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Affiliation(s)
- H. Immo Lehmann
- Department of CardiologyMassachusetts General HospitalBostonMA
- Harvard Medical SchoolCambridgeMA
| | - Krishan Sharma
- Department of CardiologyMassachusetts General HospitalBostonMA
- Harvard Medical SchoolCambridgeMA
| | - Roma Bhatia
- Harvard Medical SchoolCambridgeMA
- Department of MedicineMassachusetts General HospitalBostonMA
| | - Theresa Mills
- Department of CardiologyMassachusetts General HospitalBostonMA
| | | | - Guoping Li
- Department of CardiologyMassachusetts General HospitalBostonMA
- Harvard Medical SchoolCambridgeMA
| | - Carl Andrews
- Department of CardiologyMassachusetts General HospitalBostonMA
| | - Jay Cullivan
- Department of CardiologyMassachusetts General HospitalBostonMA
| | - Jagmeet Singh
- Department of CardiologyMassachusetts General HospitalBostonMA
- Harvard Medical SchoolCambridgeMA
| | - Theofanie Mela
- Department of CardiologyMassachusetts General HospitalBostonMA
- Harvard Medical SchoolCambridgeMA
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11
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Kiernan K, Dodge SE, Kwaku KF, Jackson LR, Zeitler EP. Racial and ethnic differences in implantable cardioverter-defibrillator patient selection, management, and outcomes. Heart Rhythm O2 2022; 3:807-816. [PMID: 36589011 PMCID: PMC9795300 DOI: 10.1016/j.hroo.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Racial and ethnic differences in treatment-cardiovascular and otherwise-have been documented in many aspects of the American health care system and can be seen in implantable cardioverter-defibrillator (ICD) patient selection, counseling, and management. ICDs have been demonstrated to be a powerful tool in the prevention of sudden cardiac death, yet uptake across all eligible patients has been modest. Although patients who do not identify as White are disproportionately eligible for ICDs in the United States, they are less likely to see specialists, be counseled on ICDs, and ultimately have an ICD implanted. This review explores racial and ethnic differences demonstrated in ICD patient selection, outcomes including shock effectiveness, and postimplantation monitoring for both primary and secondary prevention devices. It also highlights barriers for uptake at the health system, physician, and patient levels and suggests areas of further research needed to clarify the differences, illuminate the driving forces of these differences, and investigate strategies to address them.
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Affiliation(s)
- Katherine Kiernan
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Shayne E. Dodge
- Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kevin F. Kwaku
- Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Larry R. Jackson
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Emily P. Zeitler
- Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- The Dartmouth Institute, Lebanon, New Hampshire
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12
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Thomas KL, Garg J, Velagapudi P, Gopinathannair R, Chung MK, Kusumoto F, Ajijola O, Jackson LR, Turagam MK, Joglar JA, Sogade FO, Fontaine JM, Krahn AD, Russo AM, Albert C, Lakkireddy DR. Racial and ethnic disparities in arrhythmia care: A call for action. Heart Rhythm 2022; 19:1577-1593. [PMID: 35842408 PMCID: PMC10124949 DOI: 10.1016/j.hrthm.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Kevin L Thomas
- Division of Cardiac Electrophysiology, Duke University School of Medicine, Durham, North Carolina
| | - Jalaj Garg
- Cardiac Arrhythmia Service, Loma Linda University Hospital, Loma Linda, California
| | - Poonam Velagapudi
- Division of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Mina K Chung
- Cardiac Pacing and Electrophysiology, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Fred Kusumoto
- Heart Rhythm Services, Mayo Clinic, Jacksonville, Florida
| | - Olujimi Ajijola
- Ronald Reagan University of California Los Angeles Cardiac Arrhythmia Center, Los Angeles, California
| | - Larry R Jackson
- Division of Cardiac Electrophysiology, Duke University School of Medicine, Durham, North Carolina
| | - Mohit K Turagam
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jose A Joglar
- Division of Cardiology, Clinical Cardiac Electrophysiology, UT Southwestern Medical Center, Dallas, Texas
| | - Felix O Sogade
- Clinical Cardiac Electrophysiology, Georgia Arrhythmia Consultants, Macon, Georgia
| | - John M Fontaine
- Clinical Cardiac Electrophysiology Service, University of Pittsburgh Medical Center Williamsport, Williamsport, Pennsylvania
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea M Russo
- Cooper Medical School of Rowan University, Division of Cardiovascular Disease, Cooper University Hospital, Camden, New Jersey
| | - Christine Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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13
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Chahine M, Fontaine JM, Boutjdir M. Racial Disparities in Ion Channelopathies and Inherited Cardiovascular Diseases Associated With Sudden Cardiac Death. J Am Heart Assoc 2022; 11:e023446. [PMID: 35243873 PMCID: PMC9075281 DOI: 10.1161/jaha.121.023446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Cardiovascular disease (CVD) continues to be the most common cause of death worldwide, and cardiac arrhythmias account for approximately one half of these deaths. The morbidity and mortality from CVD have been reduced significantly over the past few decades; however, disparities in racial or ethnic populations still exist. This review is based on available literature to date and focuses on known cardiac channelopathies and other inherited disorders associated with sudden cardiac death in African American/Black subjects and the role of epigenetics in phenotypic manifestations of CVD, and illustrates existing disparities in treatment and outcomes. The review also highlights the knowledge gaps that limit understanding of the manifestation of phenotypic abnormalities across racial or ethnic groups and discusses disparities associated with device underuse in the management of patients at risk for sudden cardiac death. We discuss factors related to reports in the United States, that the overall mortality attributed to CVD and the number of out‐of‐hospital cardiac arrests are higher among African American/Black subjects when compared with other racial or ethnic groups. African American/Black subjects are disproportionally affected by CVD, including cardiac arrhythmias and sudden cardiac death, thus highlighting a major concern in this population that remains underrepresented in clinical trials with limited genetic testing and device underuse. The proposed solutions include (1) early identification of genetic variants, which is crucial in tailoring a preventive management strategy; (2) inclusion of diverse racial or ethnic groups in clinical trials; (3) compliance with guideline‐directed medical treatment and referral to cardiovascular subspecialists; and (4) training and mentoring of underrepresented junior faculty in cardiovascular health disparities research.
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Affiliation(s)
- Mohamed Chahine
- Department of Medicine Faculty of Medicine Université Laval Quebec City QC Canada.,CERVO Brain Research Center Quebec City QC Canada
| | - John M Fontaine
- University of Pittsburgh Medical Center Williamsport PA.,University of Central Florida School of Medicine Affiliate-West Florida Hospital Pensacola FL
| | - Mohamed Boutjdir
- Cardiovascular Research ProgramVeterans Administration New York Harbor Healthcare System New York NY.,Department of Medicine, Cell Biology and Pharmacology State University of New York Downstate Medical Center New York NY.,Department of Medicine New York University School of Medicine New York NY
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14
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Tamirisa KP, Al-Khatib SM, Mohanty S, Han JK, Natale A, Gupta D, Russo AM, Al-Ahmad A, Gillis AM, Thomas KL. Racial and Ethnic Differences in the Management of Atrial Fibrillation. CJC Open 2021; 3:S137-S148. [PMID: 34993443 PMCID: PMC8712595 DOI: 10.1016/j.cjco.2021.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 09/03/2021] [Indexed: 01/24/2023] Open
Abstract
Atrial fibrillation (AF) is the most common clinical arrhythmia, and it results in adverse outcomes and increased healthcare costs. Racial and ethnic differences in AF management, although recognized, are poorly understood. This review summarizes racial differences in AF epidemiology, genetics, clinical presentation, and management. In addition, it highlights the underrepresentation of racial and ethnic populations in AF clinical trials, especially trials focused on stroke prevention. Specific strategies are proposed for future research and initiatives that have potential to eliminate racial and ethnic differences in the care of patients with AF. Addressing racial and ethnic disparities in healthcare access, enrollment in clinical trials, resource allocation, prevention, and management will likely narrow the gaps in the care and outcomes of racial and ethnic minorities suffering from AF.
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Affiliation(s)
| | - Sana M. Al-Khatib
- Division of Cardiology, Duke University Medical Centre, Durham, North Carolina, USA
| | | | - Janet K. Han
- Division of Cardiology, Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, California, USA
- University of California Los Angeles School of Medicine, Los Angeles, California, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, Austin/Dallas, Texas, USA
| | - Dhiraj Gupta
- Department of Cardiology, University of Liverpool, London, United Kingdom
| | - Andrea M. Russo
- Division of Cardiology, Cooper University Hospital, Camden, New Jersey, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, Austin/Dallas, Texas, USA
| | - Anne M. Gillis
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kevin L. Thomas
- Division of Cardiology, Duke University Medical Centre, Durham, North Carolina, USA
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15
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Eboh O, Mao Y, Lee E, Okunrintemi V, Derbal O, Maxwell Hill S, Sears SF, Pursell I, Mounsey JP, Burch A. Out of Hospital Sudden Death in a Rural Population: Low Rates of ICD Underutilization Among Decedents. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:980-985. [PMID: 33913184 DOI: 10.1111/pace.14248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) reduce mortality in patients at risk for life-threatening arrhythmias. Implantation of ICDs in rural or economically disadvantaged populations is suspected to be low. This study examined Out of Hospital Premature Natural Death (OHPND) and electronic medical record (EMR) data to identify rates of non-implantation of ICDs among decedents in eastern North Carolina. METHODS OHPND cases in 2016 were identified using mortality data and matched with EMRs. Those meeting criteria for ICD implantation based on chart review were adjudicated by two electrophysiologists to determine whether they qualified for implantation. Comorbidity burden was established using Charlson's Comorbidity Index (CCI). RESULTS Out of 1316 OHPND cases, 967 (73.4%) had EMR records. Chart review identified 70 (7.2%) potential ICD candidates with a LVEF ≤35 of which 5 (7.1%) did not meet criteria because LVEF subsequently improved. Of the remaining 65 patients, 32 (49.2%) already received an ICD, and 33 patients (50.7%) met criteria but had not received one. Reasons for non-implantation included: limited life expectancy secondary to comorbidities, principally chronic kidney disease (CKD) (N = 11, 17%), physician non-adherence to guidelines (N = 9, 14%), loss to follow-up (N = 7, 11%), patient refusal (N = 5, 8%), and death before commencing medical therapy (N = 1, 2%). Among our cohort of 967 individuals who died unexpectedly, nine (0.9%) patients may have avoided death with an ICD. CONCLUSION This study using decedent data shows low rates of ICD-underutilization in a rural population and emphasizes the role of advanced comorbidities such as CKD in ICD-underutilization.
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Affiliation(s)
- Oghenesuvwe Eboh
- Department of Internal Medicine, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA
| | - Yuxuan Mao
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Elisabeth Lee
- Department of Internal Medicine, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA
| | - Victor Okunrintemi
- Department of Internal Medicine, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA
| | - Ouassim Derbal
- Department of Internal Medicine, Vidant Medical Center, East Carolina University, Greenville, North Carolina, USA
| | | | - Samuel F Sears
- Department of Psychology, Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina, USA
| | - Irion Pursell
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - John P Mounsey
- Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ashley Burch
- Department of Health Services and Information Management, East Carolina University, Greenville, North Carolina, USA
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16
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Thomas KL, Sullivan LT, Al-Khatib SM, LaPointe NA, Sears S, Kosinski AS, Jackson LR, Kutyifa V, Peterson ED. Videos to reduce racial disparities in ICD therapy Via Innovative Designs (VIVID) trial: Rational, design and methodology. Am Heart J 2020; 220:59-67. [PMID: 31785550 DOI: 10.1016/j.ahj.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/12/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite a higher prevalence of sudden cardiac death (SCD), black individuals are less likely than whites to have an implantable cardioverter defibrillator (ICD) implanted. Racial differences in ICD utilization is in part explained by higher refusal rates in black individuals. Decision support can assist with treatment-related uncertainty and prepare patients to make well-informed decisions. METHODS The Videos to reduce racial disparities in ICD therapy Via Innovative Designs (VIVID) study will randomize 350 black individuals with a primary prevention indication for an ICD to a racially concordant/discordant video-based decision support tool or usual care. The composite primary outcome is (1) the decision for ICD placement in the combined video groups compared with usual care and (2) the decision for ICD placement in the racially concordant relative to discordant video group. Additional outcomes include knowledge of ICD therapy and SCD risk; decisional conflict; ICD receipt at 90 days; and a qualitative assessment of ICD decision making in acceptors, decliners, and those undecided. CONCLUSIONS In addition to assessing the efficacy of decision support on ICD acceptance among black individuals, VIVID will provide insight into the role of racial concordance in medical decision making. Given the similarities in the root causes of racial/ethnic disparities in care across health disciplines, our approach and findings may be generalizable to decision making in other health care settings.
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Affiliation(s)
| | | | | | | | - Sam Sears
- East Carolina University, Department of Psychology, Greenville, NC
| | | | | | - Valentina Kutyifa
- University of Rochester Medical Center, School of Medicine and Dentistry
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17
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Mistry A, Vali Z, Sidhu B, Budgeon C, Yuyun MF, Pooranachandran V, Li X, Newton M, Watts J, Khunti K, Samani NJ, Ng GA. Disparity in implantable cardioverter defibrillator therapy among minority South Asians in the United Kingdom. Heart 2020; 106:671-676. [PMID: 31924714 DOI: 10.1136/heartjnl-2019-315978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE There are large geographical differences in implantable cardioverter defibrillator (ICD) implantation rates for reasons not completely understood. In an increasingly multiethnic population, we sought out to investigate whether ethnicity influenced ICD implantation rates. METHODS This was a retrospective, cohort study of new ICD implantation or upgrade to ICD from January 2006 to February 2019 in recipients of Caucasian or South Asian ethnicity at a single tertiary centre in the UK. Data were obtained from a routinely collected local registry. Crude rates of ICD implantation were calculated for the population of Leicestershire county and were age-standardised to the UK population using the UK National Census of 2011. RESULTS The Leicestershire population was 980 328 at the time of the Census, of which 761 403 (77.7%) were Caucasian and 155 500 (15.9%) were South Asian. Overall, 2650 ICD implantations were performed in Caucasian (91.9%) and South Asian (8.1%) patients. South Asians were less likely than Caucasians to receive an ICD (risk ratio (RR) 0.43, 95% CI 0.37 to 0.49, p<0.001) even when standardised for age (RR 0.75, 95% CI 0.74 to 0.75, p<0.001). This remained the case for primary prevention indication (age-standardised RR 0.91, 95% CI 0.90 to 0.91, p<0.001), while differences in secondary prevention ICD implants were even greater (age-standardised RR 0.49, 95% CI 0.48 to 0.50, p<0.001). CONCLUSION Despite a universal and free healthcare system, ICD implantation rates were significantly lower in the South Asian than the Caucasian population residing in the UK. Whether this is due to cultural acceptance or an unbalanced consideration is unclear.
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Affiliation(s)
- Amar Mistry
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Zakariyya Vali
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Bharat Sidhu
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Charley Budgeon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Matthew F Yuyun
- Department of Medicine, Harvard University, Boston, Massachusetts, USA.,Cardiology and Vascular Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
| | | | - Xin Li
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Michelle Newton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jamie Watts
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - G Andre Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK .,Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, United Kingdom
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18
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Racial and ethnic healthcare disparities in patients undergoing laser lead extraction. Int J Cardiol 2019; 286:181-185. [PMID: 30005833 DOI: 10.1016/j.ijcard.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/21/2018] [Accepted: 07/02/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The rate of cardiovascular implantable electronic device infections (CIEDIs) has mirrored or exceeded the increased use of implantable cardiac devices in the United States. The presence of racial and ethnic disparities associated with CIEDIs has not been published. Our aim is to describe the presence of racial and ethnic disparities with respect to the management of CIEDIs. METHODS We reviewed a prospective single-center registry for patients undergoing removal of an implantable cardiac device between 1/2004 and 1/2016. 1173 consecutive patients underwent device extraction. 699 patients were identified as having an infection, 305 were identified as Caucasian and 394 were minorities (91 African Americans, 303 Hispanics). Patients had pre-operative transesophageal echocardiograms (TEEs) and collection of blood and exudate cultures. All underwent complete hardware extraction; leads were removed through the use of locking stylets and traction or laser extraction. En-bloc capsulectomy was performed with intraoperative specimen collection from pocket tissue, exudate, lead tips, and vegetations. RESULTS Minority patients were: younger (67.9 ± 14.5 years vs 72.4 ± 13.2 years), had a higher proportion of male gender, diabetes, and chronic renal failure (p < 0.001). Minorities experienced a higher rate of complications during extraction and a longer hospitalization (15.3 ± 9.9 days versus 17.4 ± 13.4 days, p < 0.001). There was no significant difference between the proportion of types of infection in both groups. CONCLUSION Minority patients with CIEDIs experienced more procedural complications during extraction and had a significantly longer length of index hospitalization than Caucasian patients.
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19
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Lee J, Szeto L, Pasupula DK, Hussain A, Waheed A, Adhikari S, Sharbaugh M, Thoma F, Althouse AD, Fischer G, Lee JS, Saba S. Cluster Randomized Trial Examining the Impact of Automated Best Practice Alert on Rates of Implantable Defibrillator Therapy. Circ Cardiovasc Qual Outcomes 2019; 12:e005024. [DOI: 10.1161/circoutcomes.118.005024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Implantable cardioverter-defibrillators (ICDs) are indicated in patients with left ventricular ejection fraction ≤35%, but many eligible patients do not receive this therapy. In this cluster randomized trial, we investigated the impact of a best practice alert (BPA) through the electronic health records on the rates of electrophysiology referrals, ICD implantations, and all-cause mortality in severe cardiomyopathy patients.
Methods and Results:
Providers in the Heart and Vascular Institute (n=106) and in General Internal Medicine (n=89) were randomized to receive or not receive a BPA recommending consideration for ICD implantation. Patients belonging to the BPA and no BPA groups of providers were followed to the end points of electrophysiology referrals, ICD implantations, and all-cause mortality. Between 2013 and 2015, patients with reduced left ventricular ejection fraction were managed by 93 providers in the BPA (n=997 patients) and 102 providers in the no BPA (n=909 patients) groups. Patients in the 2 groups had comparable baseline characteristics. After a median follow-up of 36 months, 638 (33%) patients were referred to electrophysiology, 536 (27%) received an ICD, and 445 (23%) died. Patients in the BPA group were more likely to be referred to electrophysiology (hazard ratio=1.23;
P
=0.026), to receive ICD therapy (hazard ratio=1.35;
P
=0.006), and exhibited a trend towards slightly lower mortality (hazard ratio=0.85;
P
=0.091).
Conclusions:
Delivering a BPA through the electronic health record recommending to providers consideration of ICD implantation when the left ventricular ejection fraction is ≤35% improves the rates of electrophysiology referrals and ICD therapy in patients with severe left ventricular dysfunction.
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Affiliation(s)
- Jae Lee
- Heart and Vascular Institute, Division of Cardiology, Department of Medicine (J.S.L., M.S., F.T., A.D.A., J.L., S.S.)
| | - Libby Szeto
- University of Pittsburgh School of Medicine (L.S.)
| | | | - Aliza Hussain
- General Internal Medicine, Department of Medicine, (D.K.P, A.H., A.W., S.A., G.F.)
| | - Anam Waheed
- General Internal Medicine, Department of Medicine, (D.K.P, A.H., A.W., S.A., G.F.)
| | - Shubash Adhikari
- General Internal Medicine, Department of Medicine, (D.K.P, A.H., A.W., S.A., G.F.)
| | - Michael Sharbaugh
- Heart and Vascular Institute, Division of Cardiology, Department of Medicine (J.S.L., M.S., F.T., A.D.A., J.L., S.S.)
| | - Floyd Thoma
- Heart and Vascular Institute, Division of Cardiology, Department of Medicine (J.S.L., M.S., F.T., A.D.A., J.L., S.S.)
| | - Andrew D. Althouse
- Heart and Vascular Institute, Division of Cardiology, Department of Medicine (J.S.L., M.S., F.T., A.D.A., J.L., S.S.)
| | - Gary Fischer
- General Internal Medicine, Department of Medicine, (D.K.P, A.H., A.W., S.A., G.F.)
| | - Joon Sup Lee
- Heart and Vascular Institute, Division of Cardiology, Department of Medicine (J.S.L., M.S., F.T., A.D.A., J.L., S.S.)
| | - Samir Saba
- Heart and Vascular Institute, Division of Cardiology, Department of Medicine (J.S.L., M.S., F.T., A.D.A., J.L., S.S.)
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20
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Randolph TC, Hellkamp AS, Zeitler EP, Fonarow GC, Hernandez AF, Thomas KL, Peterson ED, Yancy CW, Al-Khatib SM. Utilization of cardiac resynchronization therapy in eligible patients hospitalized for heart failure and its association with patient outcomes. Am Heart J 2017. [PMID: 28625381 DOI: 10.1016/j.ahj.2017.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We examined trends in CRT utilization overall and by sex and race and to assess whether CRT use is associated with a reduction in HF hospitalization and mortality. BACKGROUND It is unknown whether underutilization and race/sex-based differences in cardiac resynchronization therapy (CRT) use have persisted. The association between CRT and heart failure (HF) hospitalization and mortality in real-world practice remains unclear. METHODS We linked 72,008 HF patients from 388 hospitals participating in Get With The Guidelines HF eligible for CRT with Centers for Medicare & Medicaid Services data to assess CRT utilization trends, HF hospitalization rates, and all-cause mortality. RESULTS From 2005-2014, 18,935 (26.3%) eligible patients had CRT in place, implanted, or prescribed. The majority were male (60.0%) and white (61.9%). CRT utilization increased during the study period (P = .0002) especially in the early period. Women were less likely to receive CRT, and this difference increased over time (interaction P = .0037) despite greater mortality risk reduction (interaction P = .0043). Black patients were less likely than white patients to have CRT throughout the study period (adjusted hazard ratio (HR) 0.79; 95% CI 0.74-0.85). Patients with CRT implanted during the index hospitalization had lower mortality (adjusted HR 0.65; 95% CI 0.59-0.71) and were less likely to be readmitted for HF than patients without CRT (adjusted HR 0.64; 95% CI 0.58-0.71). CONCLUSIONS/RELEVANCE CRT use has increased in all populations, but it remains underutilized. CRT remains more common among white than black HF patients, and women were less likely than men to receive CRT despite deriving greater benefit.
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2016 AHA/ACC Clinical Performance and Quality Measures for Prevention of Sudden Cardiac Death. J Am Coll Cardiol 2017; 69:712-744. [DOI: 10.1016/j.jacc.2016.09.933] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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22
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Al-Khatib SM, Yancy CW, Solis P, Becker L, Benjamin EJ, Carrillo RG, Ezekowitz JA, Fonarow GC, Kantharia BK, Kleinman M, Nichol G, Varosy PD. 2016 AHA/ACC Clinical Performance and Quality Measures for Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes 2017; 10:e000022. [DOI: 10.1161/hcq.0000000000000022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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23
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Shahid H, Singh JA. Racial/Ethnic Disparity in Rates and Outcomes of Total Joint Arthroplasty. Curr Rheumatol Rep 2016; 18:20. [PMID: 26984804 DOI: 10.1007/s11926-016-0570-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Racial/ethnic disparity in total joint arthroplasty (TJA) has grown over the last two decades as studies have documented the widening gap between Blacks and Whites in TJA utilization rates despite the known benefits of TJA. Factors contributing to this disparity have been explored and include demographics, socioeconomic status, patient knowledge, patient preference, willingness to undergo TJA, patient expectation of post-arthroplasty outcome, religion/spirituality, and physician-patient interaction. Improvement in patient knowledge by effective physician-patient communication and other methods can possibly influence patient's perception of the procedure. Such interventions can provide patient-relevant data on benefits/risks and dispel myths related to benefits/risks of arthroplasty and possibly reduce this disparity. This review will summarize the literature on racial/ethnic disparity on TJA utilization and outcomes and the factors underlying this disparity.
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Affiliation(s)
- Hania Shahid
- Department of Medicine, Rawalpindi Medical College, Rawalpindi, Pakistan.,Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Jasvinder A Singh
- Department of Medicine, School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL, USA. .,Division of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, AL, USA. .,Medicine Service, Birmingham VA Medical Center, Birmingham, AL, USA. .,Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
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Jang SW, Rho RW, Kim TS, Kim SH, Shin WS, Kim JH, Oh YS, Lee MY, Zen E, Rho TH. Differences between Korea and Japan in Physician Decision Making Regarding Permanent Pacemaker Implantation. Korean Circ J 2016; 46:654-657. [PMID: 27721856 PMCID: PMC5054177 DOI: 10.4070/kcj.2016.46.5.654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/15/2015] [Accepted: 02/02/2016] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives The number of permanent pacemakers (PPMs) implanted in patients in Japan and Korea differs significantly. We aimed to investigate the differences in decision making processes of implanting a PPM. Materials and Methods Our survey included 15 clinical case scenarios based on the 2008 AHA/ACC/HRS guidelines for device-based therapy of cardiac rhythm abnormalities (class unspecified). Members of the Korean and Japanese Societies of Cardiology were asked to rate each scenario according to a 5-point scale and to indicate their decisions for or against implantation. Results Eighty-nine Korean physicians and 192 Japanese physicians replied to the questionnaire. For the case scenarios in which there was a class I indication for PPM implantation, the decision to implant a PPM did not differ significantly between the two physician groups. However, the Japanese physicians were significantly more likely than the Korean physicians to choose implantation in class IIa scenarios (48% vs. 37%, p<0.001), class IIb scenarios (40% vs. 19%, p<0.001), and class III scenarios (36% vs. 18%, p<0.001). These results did not change when the cases were categorized based on disease entity, such as sinus node dysfunction and conduction abnormality. Conclusion Korean physicians are less likely than Japanese physicians to favor a PPM implantation when considering a variety of clinical case scenarios, which probably contributes to the relatively small number of PPMs implanted in patients in Korea as compared with those in Japan.
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Affiliation(s)
| | | | | | | | | | - Ji-Hoon Kim
- The Catholic University of Korea, Seoul, Korea
| | | | | | | | - Tai-Ho Rho
- The Catholic University of Korea, Seoul, Korea
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Pillarisetti J, Emert M, Biria M, Chotia R, Guda R, Bommana S, Pimentel R, Vacek J, Dendi R, Berenbom L, Dawn B, Lakkireddy D. Under-Utilization of Implantable Cardioverter Defibrillators in Patients with Heart Failure - The Current State of Sudden Cardiac Death Prophylaxis. Indian Pacing Electrophysiol J 2016; 15:20-9. [PMID: 25852239 PMCID: PMC4380691 DOI: 10.1016/s0972-6292(16)30838-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Despite ACC/AHA guidelines indicating implantable cardioverter defibrillator (ICD) as class I therapy for primary prevention of sudden cardiac death in patients with EF≤35%, ICD utilization rates in real world practice have been low. Objective To determine the rate of ICD implantation at a tertiary care academic center and to assess the reasons for under-utilization of the same. Methods Review of a prospectively collected database which included all patients diagnosed with an EF≤35% was performed to assess the rate of ICD implantation and mortality. Reasons for non-implantation of ICD were then assessed from detailed chart review. Results A total of 707 patients (age 69.4 ± 14.1 years) with mean EF of 26±7% were analyzed. Only 28% (200/707) of patients had ICDs implanted. Mortality was lower in the group with ICD (25% vs 37%, p=0.004). When patients who either died or were lost to follow-up prior to 2005 were excluded, ICD utilization rate was still low at 37.6%. The most common reason for non-implantation of ICD was physicians not discussing this option with their patients. Patient refusal was the second most common reason. Conclusions ICD Implantation rates for primary prevention of SCD in patients with EF≤35% is low. Physician and patient education should be addressed to improve the utilization rates.
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Affiliation(s)
- Jayasree Pillarisetti
- Section of Electrophysiology, Division of Cardiovascular Medicine, KU Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS 66193
| | - Martin Emert
- Section of Electrophysiology, Division of Cardiovascular Medicine, KU Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS 66193
| | - Mazda Biria
- Section of Electrophysiology, Division of Cardiovascular Medicine, KU Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS 66193
| | - Rashaad Chotia
- Section of Electrophysiology, Division of Cardiovascular Medicine, KU Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS 66193
| | - Rajeshwer Guda
- Section of Electrophysiology, Division of Cardiovascular Medicine, KU Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS 66193
| | - Sudharani Bommana
- Section of Electrophysiology, Division of Cardiovascular Medicine, KU Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS 66193
| | - Rhea Pimentel
- Section of Electrophysiology, Division of Cardiovascular Medicine, KU Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS 66193
| | - James Vacek
- Section of Electrophysiology, Division of Cardiovascular Medicine, KU Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS 66193
| | - Raghuveer Dendi
- Section of Electrophysiology, Division of Cardiovascular Medicine, KU Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS 66193
| | - Loren Berenbom
- Section of Electrophysiology, Division of Cardiovascular Medicine, KU Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS 66193
| | - Buddhadeb Dawn
- Section of Electrophysiology, Division of Cardiovascular Medicine, KU Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS 66193
| | - Dhanunjaya Lakkireddy
- Section of Electrophysiology, Division of Cardiovascular Medicine, KU Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS 66193
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Agarwal S, Tuzcu EM, Kapadia SR. Choice and Selection of Treatment Modalities for Cardiac Patients: An Interventional Cardiology Perspective. J Am Heart Assoc 2015; 4:e002353. [PMID: 26486167 PMCID: PMC4845140 DOI: 10.1161/jaha.115.002353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Shikhar Agarwal
- Section of Interventional CardiologyHeart and Vascular Institute, Cleveland ClinicClevelandOH
| | - E. Murat Tuzcu
- Section of Interventional CardiologyHeart and Vascular Institute, Cleveland ClinicClevelandOH
| | - Samir R. Kapadia
- Section of Interventional CardiologyHeart and Vascular Institute, Cleveland ClinicClevelandOH
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Abstract
Despite advances in evidence-based treatments, the morbidity and mortality of congestive heart failure remain exceedingly high. In addition, the costs associated with recurrent hospitalizations and advanced therapies, such as implantable cardiac defibrillators (ICDs), left ventricular assist devices, and heart transplantation, place a substantial financial burden on the health care system. The present criteria for risk stratification in patients with heart failure are inadequate and often prevent the allocation of appropriate treatment. Patients who have received ICDs as primary prevention for sudden cardiac death often receive no device therapy in their lifetime, whereas other patients with left ventricular dysfunction die suddenly without meeting criteria for ICD implantation.
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Holmqvist F, Simon D, Steinberg BA, Hong SJ, Kowey PR, Reiffel JA, Naccarelli GV, Chang P, Gersh BJ, Peterson ED, Piccini JP. Catheter Ablation of Atrial Fibrillation in U.S. Community Practice--Results From Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). J Am Heart Assoc 2015; 4:JAHA.115.001901. [PMID: 25999401 PMCID: PMC4599417 DOI: 10.1161/jaha.115.001901] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The characteristics of patients undergoing atrial fibrillation (AF) ablation and subsequent outcomes in community practice are not well described. Methods and Results Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), we investigated the prevalence and impact of catheter ablation of AF. Among 9935 patients enrolled, 5.3% had previous AF ablation. Patients with AF ablation were significantly younger, more frequently male, and had less anemia, chronic obstructive pulmonary disease, and previous myocardial infarction (P<0.05 for all analyses) than those without previous catheter ablation of AF. Ablated patients were more likely to have a family history of AF, obstructive sleep apnea, paroxysmal AF, and moderate-to-severe symptoms (P<0.0001 for all analyses). Patients with previous ablation were more often in sinus rhythm on entry into the registry (52% vs. 32%; P<0.0001). Despite previous ablation, 46% in the ablation group were still on antiarrhythmic therapy. Oral anticoagulation was prescribed in 75% of those with previous ablation versus 76% in those without previous ablation (P=0.5). The adjusted risk of death (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.52 to 1.18; P=0.2) and cardiovascular (CV) hospitalization (HR, 1.06; 95% CI, 0.90 to 1.26; P=0.5) were similar in both groups. Patients with incident AF ablation had higher risk of subsequent CV hospitalization than matched patients without incident ablation (HR, 1.67; 95% CI, 1.24 to 2.26; P=0.0008). Conclusions In U.S. clinical practice, a minority of patients with AF are managed with catheter ablation. Subsequent to ablation, there were no significant differences in oral anticoagulation use or outcomes, including stroke/non–central nervous system embolism/transient ischemic attack or death. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01165710.
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Affiliation(s)
- Fredrik Holmqvist
- Duke Clinical Research Institute, Durham, NC (F.H., D.J.S., B.A.S., S.J.H., E.D.P., J.P.P.)
| | - DaJuanicia Simon
- Duke Clinical Research Institute, Durham, NC (F.H., D.J.S., B.A.S., S.J.H., E.D.P., J.P.P.)
| | - Benjamin A Steinberg
- Duke Clinical Research Institute, Durham, NC (F.H., D.J.S., B.A.S., S.J.H., E.D.P., J.P.P.)
| | - Seok Jae Hong
- Duke Clinical Research Institute, Durham, NC (F.H., D.J.S., B.A.S., S.J.H., E.D.P., J.P.P.)
| | - Peter R Kowey
- Lankenau Hospital and Medical Research Center, Philadelphia, PA (P.R.K.)
| | | | | | - Paul Chang
- Janssen Pharmaceuticals, Inc, Raritan, NJ (P.C.)
| | | | - Eric D Peterson
- Duke Clinical Research Institute, Durham, NC (F.H., D.J.S., B.A.S., S.J.H., E.D.P., J.P.P.)
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Durham, NC (F.H., D.J.S., B.A.S., S.J.H., E.D.P., J.P.P.)
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Pokorney SD, Hellkamp AS, Yancy CW, Curtis LH, Hammill SC, Peterson ED, Masoudi FA, Bhatt DL, Al-Khalidi HR, Heidenreich PA, Anstrom KJ, Fonarow GC, Al-Khatib SM. Primary prevention implantable cardioverter-defibrillators in older racial and ethnic minority patients. Circ Arrhythm Electrophysiol 2014; 8:145-51. [PMID: 25504649 DOI: 10.1161/circep.114.001878] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Racial and ethnic minorities are under-represented in clinical trials of primary prevention implantable cardioverter-defibrillators (ICDs). This analysis investigates the association between primary prevention ICDs and mortality among Medicare, racial/ethnic minority patients. METHODS AND RESULTS Data from Get With The Guidelines-Heart Failure Registry and National Cardiovascular Data Registry's ICD Registry were used to perform an adjusted comparative effectiveness analysis of primary prevention ICDs in Medicare, racial/ethnic minority patients (nonwhite race or Hispanic ethnicity). Mortality data were obtained from the Medicare denominator file. The relationship of ICD with survival was compared between minority and white non-Hispanic patients. Our analysis included 852 minority patients, 426 ICD and 426 matched non-ICD patients, and 2070 white non-Hispanic patients (1035 ICD and 1035 matched non-ICD patients). Median follow-up was 3.1 years. Median age was 73 years, and median ejection fraction was 23%. Adjusted 3-year mortality rates for minority ICD and non-ICD patients were 44.9% (95% confidence interval [CI], 44.2%-45.7%) and 54.3% (95% CI, 53.4%-55.1%), respectively (adjusted hazard ratio, 0.79; 95% CI, 0.63-0.98; P=0.034). White non-Hispanic patients receiving an ICD had lower adjusted 3-year mortality rates of 47.8% (95% CI, 47.3%-48.3%) compared with 57.3% (95% CI, 56.8%-57.9%) for those with no ICD (adjusted hazard ratio, 0.75; 95% CI, 0.67%-0.83%; P<0.0001). There was no significant interaction between race/ethnicity and lower mortality risk with ICD (P=0.70). CONCLUSIONS Primary prevention ICDs are associated with lower mortality in nonwhite and Hispanic patients, similar to that seen in white, non-Hispanic patients. These data support a similar approach to ICD patient selection, regardless of race or ethnicity.
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Affiliation(s)
- Sean D Pokorney
- From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.)
| | - Anne S Hellkamp
- From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.)
| | - Clyde W Yancy
- From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.)
| | - Lesley H Curtis
- From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.)
| | - Stephen C Hammill
- From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.)
| | - Eric D Peterson
- From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.)
| | - Frederick A Masoudi
- From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.)
| | - Deepak L Bhatt
- From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.)
| | - Hussein R Al-Khalidi
- From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.)
| | - Paul A Heidenreich
- From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.)
| | - Kevin J Anstrom
- From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.)
| | - Gregg C Fonarow
- From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.)
| | - Sana M Al-Khatib
- From the Division of Cardiology, Duke University Medical Center (S.D.P., E.D.P., S.M.A.-K.), Duke Clinical Research Institute (S.D.P., A.S.H., L.H.C., E.D.P., H.R.A.-K., K.J.A., S.M.A.-K.), Durham, NC; Division of Cardiology, Northwestern University Medical Center, Chicago, IL (C.W.Y.); Division of Cardiovascular Disease, Mayo Clinic, Rochester, MN (S.C.H.); Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver (F.A.M.); Division of Cardiology, Brigham and Women's Hospital & Harvard Medical School, Boston, MA (D.L.B.); Division of Cardiology, Stanford University, Palo Alto, CA (P.A.H.); and Division of Cardiology, UCLA Health System, Los Angeles, CA (G.C.F.).
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Ziaeian B, Zhang Y, Albert NM, Curtis AB, Gheorghiade M, Heywood JT, Mehra MR, O'Connor CM, Reynolds D, Walsh MN, Yancy CW, Fonarow GC. Clinical effectiveness of CRT and ICD therapy in heart failure patients by racial/ethnic classification: insights from the IMPROVE HF registry. J Am Coll Cardiol 2014; 64:797-807. [PMID: 25145524 PMCID: PMC4319359 DOI: 10.1016/j.jacc.2014.05.060] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/29/2014] [Accepted: 05/30/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND Clinical trials have demonstrated benefit for cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) therapies in patients with heart failure with reduced ejection fraction (HFrEF); yet, questions have been raised with regard to the benefit of device therapy for minorities. OBJECTIVES The purpose of this study was to determine the clinical effectiveness of CRT and ICD therapies as a function of race/ethnicity in outpatients with HFrEF (ejection fraction ≤35%). METHODS Data from IMPROVE HF (Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting) were analyzed by device status and race/ethnicity among guideline-eligible patients for mortality at 24 months. Multivariate Generalized Estimating Equations analyses were conducted, adjusting for patient and practice characteristics. RESULTS The ICD/cardiac resynchronization defibrillator (CRT-D)-eligible cohort (n = 7,748) included 3,391 (44%) non-Hispanic white, 719 (9%) non-Hispanic black, and 3,638 (47%) other racial/ethnic minorities or race-not-documented patients. The cardiac resynchronization pacemaker (CRT-P)/CRT-D-eligible cohort (n = 1,188) included 596 (50%) non-Hispanic white, 99 (8%) non-Hispanic black, and 493 (41%) other/not-documented patients. There was clinical benefit associated with ICD/CRT-D therapy (adjusted odds ratio: 0.64, 95% confidence interval: 0.52 to 0.79, p = 0.0002 for 24-month mortality), which was of similar proportion in white, black, and other minority/not-documented patients (device-race/ethnicity interaction p = 0.7861). For CRT-P/CRT-D therapy, there were also associated mortality benefits (adjusted odds ratio: 0.55, 95% confidence interval: 0.33 to 0.91, p = 0.0222), and the device-race/ethnicity interaction was not significant (p = 0.5413). CONCLUSIONS The use of guideline-directed CRT and ICD therapy was associated with reduced 24-month mortality without significant interaction by racial/ethnic group. Device therapies should be offered to eligible heart failure patients, without modification based on race/ethnicity.
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Affiliation(s)
- Boback Ziaeian
- Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Yan Zhang
- Medtronic, Inc., Mounds View, Minnesota
| | - Nancy M Albert
- Nursing Institute and George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Anne B Curtis
- Department of Medicine, University at Buffalo, Buffalo, New York
| | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Mandeep R Mehra
- Division of Cardiology, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | | | - Dwight Reynolds
- Cardiovascular Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Clyde W Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles Medical Center, Los Angeles, California.
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Lyons KJ, Podder M, Ezekowitz JA. Rates and reasons for device-based guideline eligibility in patients with heart failure. Heart Rhythm 2014; 11:1983-90. [PMID: 25101484 DOI: 10.1016/j.hrthm.2014.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) are recommended by guidelines for patients with heart failure (HF) meeting specific criteria. Uncertainty exists regarding estimates of device eligibility, related in part to the method of assessing for guideline nonadherence. OBJECTIVE The aim of this study was to identify the rates of guideline eligibility and device utilization after accounting for reasons for not receiving an ICD or CRT. METHODS Patients were identified from 2006 to 2011 in a tertiary Heart Function Clinic in Canada. The chart-level data were collected that would indicate guideline eligibility and nonadherence. RESULTS A total of 762 patients with HF were included (mean age 66 years; 527 (69%) were males; median left ventricular ejection fraction 33%). Over follow-up, 331 patients (43%) were never guideline eligible whereas 431 (57%) were guideline eligible for a device. Yearly rates for ICD and CRT adherence in "guideline-eligible" patients ranged from 59% to 68% and from 66% to 81%, respectively. "Patient preference" was the most commonly documented reason for guideline nonadherence in eligible patients. After removal of patients with reasons for nonadherence, rates of ICD and CRT adherence in the "truly eligible" patients were found to be higher (70%-81% and 71%-88%, respectively) than those in guideline-eligible patients. Independent predictors of device nonadherence in truly eligible patients were age >75 years, QRS duration <120 ms, left ventricular ejection fraction <30%, and female sex. CONCLUSION Based on chart-level data, utilization rates of device-based therapies in patients with HF appear much higher than those of prior registry-based estimates. Given the importance of patient preferences for lack of device use, future quality-of-care metrics based on guideline adherence should capture detailed chart-level data and patient preferences.
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Affiliation(s)
- Kristin J Lyons
- Division of Cardiology, Department of Medicine; Mazankowski Alberta Heart Institute
| | - Mohua Podder
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
| | - Justin A Ezekowitz
- Division of Cardiology, Department of Medicine; Mazankowski Alberta Heart Institute,; Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada.
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Zhang Y, Kennedy R, Blasco-Colmenares E, Butcher B, Norgard S, Eldadah Z, Dickfeld T, Ellenbogen KA, Marine JE, Guallar E, Tomaselli GF, Cheng A. Outcomes in African Americans undergoing cardioverter-defibrillator implantation for primary prevention of sudden cardiac death: findings from the Prospective Observational Study of Implantable Cardioverter-Defibrillators (PROSE-ICD). Heart Rhythm 2014; 11:1377-83. [PMID: 24793459 DOI: 10.1016/j.hrthm.2014.04.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) reduce the risk of death in patients with left ventricular dysfunction. Little is known regarding the benefit of this therapy in African Americans (AAs). OBJECTIVE The purpose of this study was to determine the association between AA race and outcomes in a cohort of primary prevention ICD patients. METHODS We conducted a prospective cohort study of patients with systolic heart failure who underwent ICD implantation for primary prevention of sudden cardiac death. The primary end-point was appropriate ICD shock defined as a shock for rapid ventricular tachyarrhythmias. The secondary end-point was all-cause mortality. RESULTS There were 1189 patients (447 AAs and 712 non-AAs) enrolled. Over a median follow-up of 5.1 years, a total of 137 patients experienced an appropriate ICD shock, and 343 died (294 of whom died without receiving an appropriate ICD shock). The multivariate adjusted hazard ratio (95% confidence interval) comparing AAs vs non-AAs were 1.24 (0.96-1.59) for all-cause mortality, 1.33 (1.02, 1.74) for all-cause mortality without receiving appropriate ICD shock, and 0.78 (0.51, 1.19) for appropriate ICD shock. Ejection fraction, diabetes, and hypertension appeared to explain 24.1% (10.1%-69.5%), 18.7% (5.3%-58.0%), and 13.6% (3.8%-53.6%) of the excess risk of mortality in AAs, with a large proportion of the mortality difference remaining unexplained. CONCLUSION In patients with primary prevention ICDs, AAs had an increased risk of dying without receiving an appropriate ICD shock compared to non-AAs.
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Affiliation(s)
- Yiyi Zhang
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Barbara Butcher
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sanaz Norgard
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Joseph E Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eliseo Guallar
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Gordon F Tomaselli
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alan Cheng
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Hoang A, Shen C, Zheng J, Taylor S, Groh WJ, Rosenman M, Buxton AE, Chen PS. Utilization rates of implantable cardioverter-defibrillators for primary prevention of sudden cardiac death: a 2012 calculation for a midwestern health referral region. Heart Rhythm 2014; 11:849-55. [PMID: 24566233 DOI: 10.1016/j.hrthm.2014.02.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Utilization rates (URs) for implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden cardiac death (PPSCD) are lacking in the community. OBJECTIVE The purpose of this study was to establish the ICD UR in central Indiana. METHODS A query run on 2 hospitals in a health information exchange database in Indianapolis identified patients between 2011 and 2012 with left ventricular ejection fraction (EF) ≤0.35. ICD eligibility and utilization were determined from chart review. RESULTS We identified 1863 patients with at least 1 low EF study. Two cohorts were analyzed: 1672 patients without and 191 patients with International Classification of Diseases, Ninth Revision, Clinical Modification procedure code 37.94 for ICD placement. We manually reviewed a stratified (by hospital) random sample of 300 patients from the no-ICD procedure code cohort and found that 48 (16%) had no ICD but had class I indications for ICD. Eight of 300 (2.7%) actually had ICD implantation for PPSCD. Review of all 191 patients in the ICD procedure code cohort identified 70 with ICD implantation for PPSCD. The ICD UR (ratio between patients with ICD for PPSCD and all with indication) was 38% overall (95% confidence interval [CI] 28%-49%). URs were 48% for males (95% CI 34%-61%), 21% for females (95% CI 16%-26%, P = .0002 vs males), 40% for whites (95% CI 27%-53%), and 37% for blacks (95% CI 28%-46%, P = .66 vs whites). CONCLUSION ICD UR is 38% among patients meeting class I indications, suggesting further opportunities for improving guideline compliance. This study also illustrates limitations in calculating ICD UR using large electronic repositories without hands-on chart review.
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Affiliation(s)
- Allen Hoang
- Krannert Institute of Cardiology and Division of Cardiology, Indiana University, Indianapolis, Indiana
| | - Changyu Shen
- Department of Biostatistics, Indiana University, Indianapolis, Indiana; The Regenstrief Institute, Indiana University, Indianapolis, Indiana
| | - James Zheng
- Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Stanley Taylor
- Department of Biostatistics, Indiana University, Indianapolis, Indiana
| | - William J Groh
- Krannert Institute of Cardiology and Division of Cardiology, Indiana University, Indianapolis, Indiana
| | - Marc Rosenman
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana
| | - Alfred E Buxton
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Peng-Sheng Chen
- Krannert Institute of Cardiology and Division of Cardiology, Indiana University, Indianapolis, Indiana.
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Matchett M, Sears SF, Hazelton G, Kirian K, Wilson E, Nekkanti R. The implantable cardioverter defibrillator: its history, current psychological impact and future. Expert Rev Med Devices 2014; 6:43-50. [DOI: 10.1586/17434440.6.1.43] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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HAZELTON ANTHONYGARRETT, SEARS SAMUELF, FORD JESSICA, CAHILL JOHN, NEKKANTI RAJASEKHAR, DEANTONIO HARRY, OTTOBONI LINDA, NORTON LINDA, WANG PAUL. Decisional Balance among Potential Implantable Cardioverter Defibrillator Recipients: Development of the ICD-Decision Analysis Scale (ICD-DAS). PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:63-72. [DOI: 10.1111/pace.12253] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 06/20/2013] [Accepted: 07/11/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - SAMUEL F. SEARS
- Department of Psychology; East Carolina University; Greenville North Carolina
- Department of Cardiovascular Sciences; East Carolina University; Greenville North Carolina
| | - JESSICA FORD
- Department of Psychology; East Carolina University; Greenville North Carolina
| | - JOHN CAHILL
- Department of Cardiovascular Sciences; East Carolina University; Greenville North Carolina
| | - RAJASEKHAR NEKKANTI
- Department of Cardiovascular Sciences; East Carolina University; Greenville North Carolina
| | - HARRY DEANTONIO
- Department of Cardiovascular Sciences; East Carolina University; Greenville North Carolina
| | - LINDA OTTOBONI
- Department of Cardiovascular Medicine; Stanford University Medical Center; Stanford California
| | - LINDA NORTON
- Department of Cardiovascular Medicine; Stanford University Medical Center; Stanford California
| | - PAUL WANG
- Department of Cardiovascular Medicine; Stanford University Medical Center; Stanford California
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Miller AL, Gosch K, Daugherty SL, Rathore S, Peterson PN, Peterson ED, Ho PM, Chan PS, Lanfear DE, Spertus JA, Wang TY. Failure to reassess ejection fraction after acute myocardial infarction in potential implantable cardioverter/defibrillator candidates: insights from the Translational Research Investigating Underlying disparities in acute Myocardial infarction Patients' Health Status (TRIUMPH) registry. Am Heart J 2013; 166:737-43. [PMID: 24093855 DOI: 10.1016/j.ahj.2013.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 07/08/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Current practice guidelines advocate delaying assessment of primary prevention implantable cardioverter/defibrillator (ICD) candidacy at least 40 days after an acute myocardial infarction (AMI) because early ICD implantation after AMI has not demonstrated survival benefit. The rate at which interval reassessment of left ventricular ejection fraction (LVEF) occurs in potential primary prevention ICD candidates is unknown. METHODS We examined patients with AMI in the TRIUMPH registry with inhospital LVEF <40% discharged alive after their index presentation, excluding patients with a prior ICD and those who declined ICD during the index admission or were discharged to hospice. We conducted multivariable Poisson modeling to identify independent factors associated with LVEF reassessment by 6 months after AMI. RESULTS Of the 533 patients meeting the inclusion criteria, only 187 (35.1%) reported LVEF reassessment in the first 6 months after AMI and only 13 patients (2.4%) underwent ICD implantation by 1 year. In multivariable analysis, early cardiology follow-up after AMI was associated with a higher likelihood of LVEF reassessment (odds ratio 1.16, 95% confidence interval 1.06-1.28), whereas uninsured status and cardiologist-driving inpatient medical decision making were associated with a lower likelihood of LVEF reassessment (odds ratios 0.84 [95% CI 0.74-0.96] and 0.78 [95% CI 0.68-0.91], respectively). CONCLUSIONS In contemporary practice, almost 2 of 3 potential primary prevention ICD candidates did not report follow-up LVEF evaluation, with a very low rate of ICD implantation at 1 year. These results suggest an important gap in quality, highlighting the need for better transitions of care.
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Gupta A, Dharmarajan K, Dreyer R, Bikdeli B, Chen R, Kulkarni VT, Shi R, Shojaee A, Ranasinghe I. Most Important Outcomes Research Papers on Device Therapies for Cardiomyopathies. Circ Cardiovasc Qual Outcomes 2013. [DOI: 10.1161/circoutcomes.113.000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gupta A, Lampropulos JF, Bikdeli B, Mody P, Chen R, Kulkarni VT, Dharmarajan K. Most important outcomes research papers on cardiovascular disease in women. Circ Cardiovasc Qual Outcomes 2013; 6:e1-7. [PMID: 23322810 DOI: 10.1161/circoutcomes.112.970202] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Thomas KL, Zimmer LO, Dai D, Al-Khatib SM, Allen LaPointe NM, Peterson ED. Educational videos to reduce racial disparities in ICD therapy via innovative designs (VIVID): a randomized clinical trial. Am Heart J 2013; 166:157-63. [PMID: 23816035 DOI: 10.1016/j.ahj.2013.03.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/07/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Black individuals eligible for an implantable cardioverter/defibrillator (ICD) are considerably less likely than white individuals to receive one. This disparity may, in part, be explained by racial differences in patient preferences. We hypothesized that a targeted patient-centered educational video could improve knowledge of sudden cardiac arrest (SCA) and ICDs and reduce racial differences in ICD preferences. We conducted a pilot study to assess the feasibility of testing this hypothesis in a randomized trial. METHODS We created a video that included animation, physician commentary, and patient testimonials on SCA and ICDs. The primary outcome was the decision to have an ICD implanted as a function of race and intervention. Between January 1, 2011, and December 31, 2011, 59 patients (37 white and 22 black) were randomized to the video or health care provider counseling/usual care. RESULTS Relative to white patients, black patients were younger (median age, 55 vs 68 years) and more likely to have attended college or technical school. Baseline SCA and ICD knowledge was similar and improved significantly in both racial groups after the intervention. Black patients viewing the video were as likely as white patients to want an ICD (60.0% vs 79.2%, P = .20); and among those in the usual care arm, black patients were less likely than white patients to want an ICD (42.9% vs 84.6% P = .05). CONCLUSION Among individuals eligible for an ICD, a video decision aid increased patient knowledge and reduced racial differences in patient preference for an ICD.
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Affiliation(s)
- Kevin L Thomas
- Duke Clinical Research Institute, Durham, NC 27710, USA.
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Pertzov B, Novack V, Zahger D, Katz A, Amit G. Insufficient compliance with current implantable cardioverter defibrillator (ICD) therapy guidelines in post myocardial infarction patients is associated with increased mortality. Int J Cardiol 2013; 166:421-4. [DOI: 10.1016/j.ijcard.2011.10.132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 10/13/2011] [Accepted: 10/29/2011] [Indexed: 11/16/2022]
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The association between patient race, treatment, and outcomes of patients undergoing contemporary percutaneous coronary intervention: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). Am Heart J 2013; 165:893-901.e2. [PMID: 23708159 DOI: 10.1016/j.ahj.2013.02.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 02/16/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND The aim of this study was to examine if racial disparities exist in the treatment and outcomes of patients undergoing contemporary percutaneous coronary intervention (PCI). METHODS We examined the association between race, process of care, and outcomes of patients undergoing PCI between January 1, 2010, and December 31, 2011, and enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. We used propensity matching to compare the outcome of black and white patients. RESULTS The study cohort comprised 65,175 patients, of whom 6,873 (10.5%) were black and 55,789 (85.6%) were white. Black patients were more likely to be younger, be female, have more comorbidities, and be uninsured. Overall, black patients were less likely to receive prasugrel (10.0% vs 14.5%, P < .001) and drug-eluting stents (62.5% vs 67.7%, P < .001), largely related to lower use of these therapies in hospitals treating a higher proportion of black patients. No differences were seen between white and black patients with regard to inhospital mortality (odds ratio 1.34, 95% CI 0.82-2.2, P = .24), contrast-induced nephropathy (OR 1.06, 95% CI 0.81-1.40, P = .67), and need for transfusion (OR 1.27, 95% CI 0.98-1.64, P = .06). White race was associated with increased odds of heart failure (OR 1.48, 95% CI 1.05-2.08, P = .024) and vascular complications (OR 1.40, 95% CI 1.03-1.90, P = .032). CONCLUSIONS Compared with white patients, black patients undergoing PCI have a greater burden of comorbidities but, after adjusting for these differences, have similar inhospital survival and lower odds of vascular complications and heart failure after PCI.
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Al-Khatib SM, Fonarow GC, Hayes DL, Curtis AB, Sears SF, Sanders GD, Hernandez AF, Mirro MJ, Thomas KL, Eapen ZJ, Russo AM, Yancy CW. Performance measures to promote quality improvement in sudden cardiac arrest prevention and treatment. Am Heart J 2013; 165:862-8. [PMID: 23708156 DOI: 10.1016/j.ahj.2013.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 02/14/2013] [Indexed: 11/25/2022]
Abstract
Sudden cardiac arrest (SCA) is one of the most impactful public health problems in the United States. Despite the progress made in reducing the number of cardiac deaths, the incidence of sudden cardiac death remains high. Studies of life-saving interventions for prevention and treatment of SCA, like β-blockers, aldosterone antagonists, implantable cardioverter defibrillator therapy, automated external defibrillators, and cardiopulmonary resuscitation, have brought to light substantial underutilization, variations in care, and disparities. Thus, a comprehensive systems-based approach to addressing these gaps in care should be implemented. In addition to educating stakeholders about SCA and its prevention and developing tools that could help physicians identify patients who could benefit from primary prevention of SCA, robust performance measures with strong, evidence-based association between process performance and patient outcomes are needed. In this article, we review the burden of SCA and highlight the need to develop performance measures related to the prevention and treatment of SCA.
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Eapen ZJ, McBroom AJ, Gray R, Musty MD, Hadley C, Hernandez AF, Sanders GD. Priorities for Comparative Effectiveness Reviews in Cardiovascular Disease. Circ Cardiovasc Qual Outcomes 2013; 6:139-47. [DOI: 10.1161/circoutcomes.111.000046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zubin J. Eapen
- From the Duke Evidence-based Practice Center (Z.J.E., A.J.M., R.G., M.D.M., C.H., A.F.H., G.D.S.) and Department of Medicine (Z.J.E., A.F.H., G.D.S.), Duke Clinical Research Institute, Duke University, Durham, NC
| | - Amanda J. McBroom
- From the Duke Evidence-based Practice Center (Z.J.E., A.J.M., R.G., M.D.M., C.H., A.F.H., G.D.S.) and Department of Medicine (Z.J.E., A.F.H., G.D.S.), Duke Clinical Research Institute, Duke University, Durham, NC
| | - Rebecca Gray
- From the Duke Evidence-based Practice Center (Z.J.E., A.J.M., R.G., M.D.M., C.H., A.F.H., G.D.S.) and Department of Medicine (Z.J.E., A.F.H., G.D.S.), Duke Clinical Research Institute, Duke University, Durham, NC
| | - Michael D. Musty
- From the Duke Evidence-based Practice Center (Z.J.E., A.J.M., R.G., M.D.M., C.H., A.F.H., G.D.S.) and Department of Medicine (Z.J.E., A.F.H., G.D.S.), Duke Clinical Research Institute, Duke University, Durham, NC
| | - Corey Hadley
- From the Duke Evidence-based Practice Center (Z.J.E., A.J.M., R.G., M.D.M., C.H., A.F.H., G.D.S.) and Department of Medicine (Z.J.E., A.F.H., G.D.S.), Duke Clinical Research Institute, Duke University, Durham, NC
| | - Adrian F. Hernandez
- From the Duke Evidence-based Practice Center (Z.J.E., A.J.M., R.G., M.D.M., C.H., A.F.H., G.D.S.) and Department of Medicine (Z.J.E., A.F.H., G.D.S.), Duke Clinical Research Institute, Duke University, Durham, NC
| | - Gillian D. Sanders
- From the Duke Evidence-based Practice Center (Z.J.E., A.J.M., R.G., M.D.M., C.H., A.F.H., G.D.S.) and Department of Medicine (Z.J.E., A.F.H., G.D.S.), Duke Clinical Research Institute, Duke University, Durham, NC
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Havmoeller R, Reinier K, Teodorescu C, Uy-Evanado A, Mariani R, Gunson K, Jui J, Chugh SS. Low rate of secondary prevention ICDs in the general population: multiple-year multiple-source surveillance of sudden cardiac death in the Oregon Sudden Unexpected Death Study. J Cardiovasc Electrophysiol 2012; 24:60-5. [PMID: 22860692 DOI: 10.1111/j.1540-8167.2012.02407.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Sudden cardiac death (SCD) is a large public health problem that warrants on-going evaluation in the general population. While single-year community-based studies have been performed there is a lack of studies that have extended evaluation to multiple years in the same community. METHODS AND RESULTS From the on-going Oregon Sudden Unexpected Death Study, we analyzed prospectively identified SCD cases in Multnomah County, Ore, (population ≈700,000) from February 1, 2002 to January 31, 2005. Detailed information ascertained from multiple sources (first responders, clinical records, and medical examiner) was analyzed. A total of 1,175 SCD cases were identified (61% male) with a mean age of 65 ± 18 years for men versus 70 ± 20 for women (P < 0.001). The overall incidence rate for the period was 58/100,000 residents/year. One-quarter (24.6%) was ≤ 55 years of age. The most common initial rhythm was ventricular tachycardia or fibrillation (39% of cases, survival 27%) followed by asystole (36%, survival 0.7%) and pulseless electrical activity (23%, survival 6%). Among subjects that underwent resuscitation, the rate of survival to hospital discharge was 12% and overall survival to hospital discharge irrespective of resuscitation was 8%. Of the 68 survivors, 16 (24%) received a secondary prevention ICD. CONCLUSION We report annualized SCD incidence from a multiple-year, multiple-source community-based study, with higher than expected rates of women and subjects age ≤ 55 years. The low implantation rate of secondary prevention ICDs is likely to be multifactorial, but there are potential implications for recalibration of the projected need for ICD implantation; larger and more detailed studies are warranted.
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Affiliation(s)
- Rasmus Havmoeller
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Siegel B, Sears V, Bretsch JK, Wilson M, Jones KC, Mead H, Hasnain-Wynia R, Ayala RK, Bhalla R, Cornue CM, Emrich CM, Patel P, Setzer JR, Suitonu J, Velazquez EJ, Eagle KA, Winniford MD. A Quality Improvement Framework for Equity in Cardiovascular Care: Results of a National Collaborative. J Healthc Qual 2012; 34:32-42; quiz 42-3. [DOI: 10.1111/j.1945-1474.2011.00196.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Al-Khatib SM, Hellkamp AS, Hernandez AF, Fonarow GC, Thomas KL, Al-Khalidi HR, Heidenreich PA, Hammill S, Yancy C, Peterson ED. Trends in use of implantable cardioverter-defibrillator therapy among patients hospitalized for heart failure: have the previously observed sex and racial disparities changed over time? Circulation 2012; 125:1094-101. [PMID: 22287589 DOI: 10.1161/circulationaha.111.066605] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prior studies have demonstrated low use of implantable cardioverter defibrillators (ICDs) as primary prevention, particularly among women and blacks. The degree to which the overall use of ICD therapy and disparities in use have changed is unclear. METHODS AND RESULTS We examined 11 880 unique patients with a history of heart failure and left ventricular ejection fraction ≤35% who were ≥65 years old and enrolled in the Get With the Guidelines-Heart Failure (GWTG-HF) program from January 2005 through December 2009. We determined the rate of ICD use by year for the overall population and for sex and race groups. From 2005 to 2007, overall ICD use increased from 30.2% to 42.4% and then remained unchanged in 2008 to 2009. After adjustment for potential confounders, ICD use increased significantly in the overall study population during 2005 to 2007 (odds ratio, 1.28; 95% confidence interval, 1.11-1.48 per year; P=0.0008) and in black women (odds ratio, 1.82; 95% confidence interval, 1.28-2.58 per year; P=0.0008), white women (odds ratio, 1.30; 95% confidence interval, 1.06-1.59 per year; P=0.010), black men (odds ratio, 1.54; 95% confidence interval, 1.19-1.99 per year; P=0.0009), and white men (odds ratio, 1.25; 95% confidence interval, 1.06-1.48 per year; P=0.0072). The increase in ICD use was greatest among blacks. CONCLUSIONS In the GWTG-HF quality improvement program, a significant increase in ICD therapy use was observed over time in all sex and race groups. The previously described racial disparities in ICD use were no longer present by the end of the study period; however, sex differences persisted.
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Affiliation(s)
- Sana M Al-Khatib
- MHS, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27715, USA.
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MEHRA MANDEEPR, ALBERT NANCYM, CURTIS ANNEB, GHEORGHIADE MIHAI, HEYWOOD JTHOMAS, LIU YANG, O’CONNOR CHRISTOPHERM, REYNOLDS DWIGHT, WALSH MARYNORINE, YANCY CLYDEW, FONAROW GREGGC. Factors Associated with Improvement in Guideline-Based Use of ICDs in Eligible Heart Failure Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:135-45. [DOI: 10.1111/j.1540-8159.2011.03279.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Mezu U, Ch I, Halder I, London B, Saba S. Women and minorities are less likely to receive an implantable cardioverter defibrillator for primary prevention of sudden cardiac death. Europace 2011; 14:341-4. [DOI: 10.1093/europace/eur360] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Eapen ZJ, Peterson ED, Fonarow GC, Sanders GD, Yancy CW, Sears SF, Carlson MD, Curtis AB, Hall LL, Hayes DL, Hernandez AF, Mirro M, Prystowsky E, Russo AM, Thomas KL, Al-Khatib SM. Quality of care for sudden cardiac arrest: Proposed steps to improve the translation of evidence into practice. Am Heart J 2011; 162:222-31. [PMID: 21835281 DOI: 10.1016/j.ahj.2011.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 04/26/2011] [Indexed: 11/16/2022]
Abstract
Sudden cardiac arrest (SCA) is the most common cause of death in the United States. Despite national guidelines, patients at risk for SCA often fail to receive evidence-based therapies. Racial and ethnic minorities and women are at particularly high risk for undertreatment. To address the persistent challenges in improving the quality of care for SCA, the Duke Center for the Prevention of Sudden Cardiac Death at the Duke Clinical Research Institute (Durham, NC) reconvened the Sudden Cardiac Arrest Thought Leadership Alliance. Experts from clinical cardiology, cardiac electrophysiology, health policy and economics, the US Food and Drug Administration, the Centers for Medicare and Medicaid Services, the Agency for Health Care Research and Quality, and device and pharmaceutical manufacturers discussed the development of SCA educational tools for patients and providers, mechanisms of implementing successful tools to help providers identify patients in their practice at risk for SCA, disparities in SCA prevention, and performance measures related to SCA care. This article summarizes the discussions held at this meeting.
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Affiliation(s)
- Zubin J Eapen
- Duke Clinical Research Institute, Durham, NC 27715, USA
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Al-Khatib SM, Sanders GD, O'Brien SM, Matlock D, Zimmer LO, Masoudi FA, Peterson E. Do physicians' attitudes toward implantable cardioverter defibrillator therapy vary by patient age, gender, or race? Ann Noninvasive Electrocardiol 2011; 16:77-84. [PMID: 21251138 DOI: 10.1111/j.1542-474x.2010.00412.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Sana M Al-Khatib
- Duke Cardiovascular Center for Education and Research on Therapeutics, Duke Clinical Research Institute, Durham, NC, USA.
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