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?

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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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