Thurssday, October 4, 2007

ICDs Underused in Women, Minorities with Heart Failure
by Kelly Winget, DCRI Communications

Even though cardiovascular disease is the leading cause of death of women in the U.S., they are less likely to receive potentially life-saving therapy than men when they are hospitalized for heart failure, according to two recent studies.

Researchers at the DCRI on two different research teams found that among patients hospitalized for heart failure, many seemingly eligible patients did not receive an implantable cardioverter defibrillator (ICD). The discrepancy of who most often received a device varied between gender and race.

Of the 35 percent of eligible patients who receive an ICD, the DCRI's Adrian Hernandez, MD, lead author of one of the studies, found that black men are 25 percent less likely to receive an ICD to treat heart failure than white men, and women, black or white, are 50 percent less likely to receive the device than white men. The study led by the DCRI's Lesley Curtis, Ph.D., found that men were two to three times more likely to receive an ICD than a woman.

“Clinical trials show that ICDs save lives, so the sex difference in treatment rates is worrisome,” said Curtis.

Both study findings are published in the October 3 issue of the Journal of the American Medical Association.

An ICD constantly monitors the heart's rhythm and uses small electrical shocks to help control erratic rhythms that could make the heart stop beating.

Hernandez' research team reviewed data over a two-year period on 13,034 patients hospitalized for heart failure in 217 hospitals that are participating in the American Heart Association's Get With The Guidelines – Heart Failure quality improvement program. Curtis' team analyzed the records of more than 236,000 Medicare patients between 1999 and 2005.

“Cardiovascular disease is the leading cause of death for women, and survival among women with heart failure has not improved substantially over the past 10 to 20 years,” said Hernandez. “Increasing ICD use among eligible women with heart failure highlights one potential way that we could improve outcomes.”

Guidelines for ICDs recommend using them in patients with heart failure who also score low when measured on the heart's ability to pump blood. There is no research to indicate that sex or race should be a factor when prescribing ICDs, according to the DCRI's Eric Peterson, MD, a cardiologist who was a senior member of Hernandez' research team.

Hernandez and his team are concerned that the discrepancy between who receives ICDs might be an even bigger problem in hospitals that aren't participating in the AHA's voluntary heart failure quality improvement program, since the hospitals in the study are already interested in doing their best to comply with practice guidelines. Researchers do not know why there are discrepancies in prescribing ICDs but said that physicians might approach women and black patients with different assumptions about their health care needs. Curtis said that physicians might also perceive men to be at higher risk than women with heart failure.

Other DCRI researchers that were part of Hernandez' study include Li Liang, Ph.D., Sana Al-Khatib , MD , and Lesley Curtis. Other DCRI authors on Curtis' team include Alisa Shea, MPH, Bradley Hammill, MS, Hernandez and Al-Khatib.