Disparity in Utilization of Implantable Cardioverter-Defibrillators in Treatment of Heart Failure based on Sex and Race

Evaluation of: Hernandez AF, Fonarow GC, Lang L et al.: Sex and racial differences in the use of implantable cardioverter-defibrillators among patients hospitalized with heart failure. JAMA298(13), 1525–1532 (2007) [ 1 ]. Disparity of utilization of proven therapies for treatment of cardiac disease according to gender and ethnicity has been well documented in various aspects of cardiac care. Implanted cardiac defibrillators (ICDs) are devices that have been proven to prevent sudden cardiac death. This retrospective study examined ICD use in heart-failure patients who had an indication for ICD implantation, from the “Get with the Guidelines” program. The patients were stratified by gender and ethnicity (Black vs White). The overall rate of utilization (or intention for utilization) of ICDs was 35%, while among women and Black people the rate was significantly lower, at 27 and 23%, respectively, with the lowest rate being for Black women (28%). These findings suggest a bias against implantation of such devices in women and Black people, which is not explained by clinical variables.