ICDs are underused in clinical practice—especially in women and minorities

A trio of studies presented at the Heart Rhythm Society’s 40th annual scientific sessions earlier this month highlight significant disparities in patient access to implantable cardiac devices—particularly in women and black patients.

The analyses looked at electronic health record (EHR) datasets and algorithms developed as a part of the Medtronic GLIDE HF initiative, according to a release, in an effort to quantify the usage of devices like implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) in the U.S. ICDs and CRT pacemakers and defibrillators can be lifesaving for patients with heart rhythm abnormalities, but until now nobody had studied the wider impact of the latest society-issued guidelines.

In one analysis, Anne B. Curtis, MD, a study author and professor at the University of Buffalo, and her colleagues analyzed EHR data from more than 1 million patients, identifying considerable treatment gaps between genders and races. Based on 2012 medical society guidelines, the team reported cardiac devices were implanted more often in indicated men than in indicated women (16.7% compared to 12.7%, respectively), and both women and men of color and white women saw lower usage rates than white men.

Though white men benefited from appropriate ICD or CRT therapy more often than any other demographic, Curtis and her co-authors said implantable devices were still noticeably underused across all populations.

“Device usage across both gender and race was strikingly low, despite medical records documenting patient eligibility for the therapy,” Curtis said in the release. “The breadth of practice type—from academic medical centers to community hospitals—along with the sheer number of patients highlight the seriousness of the challenge.”

Looking at four-year utilization rates of device therapies in more than 100,000 heart failure patients, the researchers said ICDs and CRT defibrillators were used far less than other CV interventions, like imaging, drug therapy or coronary procedures. Just 32.3% of eligible patients received CRT, and 11% of eligible patients received ICDs.

The last analysis of EHR data assessed referral and implant patterns in ICD-indicated patients, ultimately finding 50.5% of ICD-indicated patients were referred to an electrophysiologist to discuss implant options. Electrophysiologists are typically the physicians who implant patients’ devices, and patients referred to and seen by an electrophysiologist were more likely to receive ICDs.

Around 44.3% of patients referred to an electrophysiologist received a device, the authors reported, while just 8.8% of those who didn’t see a specialist received an ICD.

“While each of these analyses evaluated different aspects of implantable cardiac device use, the unifying theme is that far too many patients are not getting all of the therapies that could provide them with significant benefit,” Rob Kowal, MD, PhD, VP and CMO of the cardiac rhythm and heart failure division at Medtronic, said in the release. “Implantable defibrillators and CRT defibrillators are lifesaving devices, so there is a clear need to address barriers to proper care for indicated patients.”