Racial differences in setting of implantable cardioverter-defibrillator placement in older adults with heart failure and association with disparate post-implant outcomes

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Larry R Jackson¹  Ehimare Akhabue²  Melanie Rua³  Poonam Gandhi³  Soko Setoguchi⁴  Nathaniel Kuhrt⁵  Aayush Visaria⁶  Uri Shalmon⁶ 

[1] Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States;Division of Cardiovascular Diseases and Hypertension, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States;Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States;Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States;Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States;Rutgers New Jersey Medical School, Newark, NJ, United States;Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States;

关键词: cardiovascular outcomes;    implantable cardioverter-defibrillator;    heart failure;    primary prevention;    racial and ethnic differences;   

DOI  :  10.3389/fcvm.2023.1197353

 received in 2023-03-30, accepted in 2023-08-21,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundImplantable cardioverter-defibrillator (ICD) placement in heart failure (HF) patients during or early after (≤90 days) unplanned cardiovascular hospitalizations has been associated with poor outcomes. Racial and ethnic differences in this “peri-hospitalization” ICD placement have not been well described.MethodsUsing a 20% random sample of Medicare beneficiaries, we identified older (≥66 years) patients with HF who underwent ICD placement for primary prevention from 2008 to 2018. We investigated racial and ethnic differences in frequency of peri-hospitalization ICD placement using modified Poisson regression. We utilized Kaplan-Meier analyses and Cox regression to investigate the association of peri-hospitalization ICD placement with differences in all-cause mortality and hospitalization (HF, cardiovascular and all-cause) within and between race and ethnicity groups for up to 5-year follow-up.ResultsAmong the 61,710 beneficiaries receiving ICDs (35% female, 82% White, 10% Black, 6% Hispanic), 44% were implanted peri-hospitalization. Black [adjusted rate ratio (RR) 95% Confidence Interval (95% CI): 1.16 (1.12, 1.20)] and Hispanic [RR (95% CI): 1.10 (1.06, 1.14)] beneficiaries were more likely than White beneficiaries to have ICD placement peri-hospitalization. Peri-hospitalization ICD placement was associated with an at least 1.5× increased risk of death, 1.5× increased risk of re-hospitalization and 1.7× increased risk of HF hospitalization during 3-year follow-up in fully adjusted models. Although beneficiaries with peri-hospitalization placement had the highest mortality and readmission rates 1- and 3-year post-implant (log-rank p < 0.0001), the magnitude of the associated risk did not differ significantly by race and ethnicity (p = NS for interaction).ConclusionsICD implantation occurring during the peri-hospitalization period was associated with worse prognosis and occurred at higher rates among Black and Hispanic compared to White Medicare beneficiaries with HF during the period under study. The risk associated with peri-hospitalization ICD placement did not differ by race and ethnicity. Future paradigms aimed at enhancing real-world effectiveness of ICD therapy and addressing disparate outcomes should consider timing and setting of ICD placement in HFrEF patients who otherwise meet guideline eligibility.

【 授权许可】

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© 2023 Akhabue, Kuhrt, Gandhi, Rua, Shalmon, Visaria, Jackson and Setoguchi.