medwireNews: Less than a quarter of heart failure (HF) patients eligible for implantable cardioverter-defibrillator (ICD) counselling actually receive it, with the rates even lower in women and ethnic minority patients, an observational analysis of the Get With The Guidelines-HF Program shows.
This is despite ICD counselling being a measure of HF quality of care in the USA since 2012, Paul Hess (University of Colorado School of Medicine, Denver, USA) and colleagues report.
They analysed data for 21,059 patients admitted to 236 sites between 2011 and 2014 with HF and an ejection fraction of 35% or less. Of these, 4755 (22.6%) received pre-discharge ICD counselling.
The researchers found that women were counselled significantly less frequently than men, at 19.3% versus 24.6%, and were a significant 16% less likely than men to receive counselling after the data were adjusted for age and other clinical factors.
In addition, patients from racial and ethnic minorities were significantly less likely to receive counselling than White patients, at rates of 24.3% versus 22.6%, 18.6% and 14.4% for Black, Hispanic and other race/ethnicity patients, respectively. The equivalent adjusted odds ratios compared with White patients were 0.69, 0.62 and 0.53, respectively.
Of note, the rate of ICD counselling decreased slightly over time, from 23.2% in 2011 to 21.8% in 2014.
Of the patients who underwent counselling, 2977 (62.6%) received or were prescribed an ICD, and the rate was similar for men (62.3%) and women (63.1%).
By contrast, the racial/ethnic disparities remained, with Black, Hispanic and other race/ethnicity patients a significant 31%, 30% and 32% less likely to receive or be prescribed an ICD than White patients.
Hess and co-authors note that patients counselled at larger hospitals, and at centres able to perform heart transplantation and coronary artery bypass grafting were more likely to receive counselling and ultimately an ICD than those treated in other hospitals.
This suggests “that hospital-level improvement efforts may prove effective” in improving ICD use in future, they remark.
However, “[t]o further increase ICD use, efforts specifically targeting ICD counseling are needed”, the researchers write in Circulation.
They suggest that culturally appropriate counselling and web- or video-based decision aids may be helpful, but conclude: “Further study regarding the most effective means of reducing this important health disparity is needed.”
By Laura Cowen
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