HRS: For ICD patients, blacks die less, whites have less readmission

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DENVER—Regarding outcomes in patients with implantable cardioverter-defibrillators (ICDs), Caucasians had fewer hospital readmissions and African-Americans had a lower mortality rate, reported Wisconsin researchers during a poster study presentation last week at the 31st annual scientific sessions of the Heart Rhythm Society (HRS).

According to the authors, there is no data on racial differences that result in increased complications or benefits from ICD implant.

Andleeb S. Bangash, MD, from Aurora Cardiovascular Services in Milwaukee, and colleagues from other institutions throughout Wisconsin reviewed 1,533 consecutive patients (mean age,  66.9 years, 72.7 percent male; mean ejection fraction 29.2 percent), who received an ICD between January 2007 and June 2009. Of the 1,533 patients, 81.8 percent were Caucasian (Group One), 14.7 percent were African-American (Group Two) and 3.4 percent were Hispanic (Group Three).

The researchers compared occurrence of in-hospital and post-discharge adverse reactions, in-hospital and post-discharge events (acute MI and arrhythmia), readmission and mortality (cardiac and all-cause). The median follow-up was 501 days.

Among the groups, Group Two was younger: 59 versus 68.8 percent in Group One and 62.1 in Group Three, the investigators reported. Also, Group Two had fewer males than females: 58.8 percent versus Group One and 65.4 percent in Group Three.

Besides those considerations, Bangash and colleagues reported that the comorbidities were similar, except Group Two had less coronary artery disease (46.5 percent vs. 69.5 percent in Group One and 65.4 percent in Group Three); and more hypertension (84.5 percent vs. 73.6 percent in Group One and 71.2 percent in Group Three).

For other comorbidities, Group Three had more diabetes mellitus (50 percent vs. 34.1 percent in Group One and 37.2 percent in Group Two).

Among the study subjects, the researchers found there was no difference in adverse reaction rates, both in-house (1.8 percent vs. 0.9 percent vs. 1.9 percent in Groups One, Two and Three, respectively) and post-discharge (5.5 percent vs. 8 percent vs. 1 percent in Groups One, Two and Three, respectively).

Likewise, they didn’t find any difference in acute MI prior to 30 days of ICD implant or 30 days after implant. Bangash and colleagues didn’t discover any differences in arrhythmia 30 days before or 30 days after ICD implant.

However, the researchers reported that the Caucasians (Group One, 32.9 percent) had a lower readmission rate than the African-American arm (Group Two, 43.3 percent) and the Hispanic arm (Group Three, 43.3 percent).

Conversely, Bangash and colleagues reported that the African-American arm had a lower mortality rate (Group Two, 5.8 percent), compared with the other arms (13.6 percent in Group One and 29.2 percent in Group Three), mainly due to cardiac causes (0 percent vs. 11.2 percent in Group One and 15.4 percent in Group Three).