‘Surprising’ trends in ICD use among HCM patients
Implantable cardioverter-defibrillators (ICDs) are underused among female and non-white hypertrophic cardiomyopathy (HCM) patients, according to new research published in Mayo Clinic Proceedings.
The study’s authors examined data from the National Inpatient Sample, focusing on more than 23,000 adult admissions for HCM from January 2003 to December 2014.
ICD implantation occurred during 16.8% of included HCM admissions, the group noted, and it became more common over time. They were implanted in 11.6% of patients in 2003, for instance, but 17% of patients in 2014.
Receiving an ICD, meanwhile, was associated with shorter lengths of stay and—as one might anticipate—higher healthcare costs.
Looking closely and who did and did not receive an ICD, the group highlighted the fact that implantation was less common among women and non-white patients. However, even with that trend in mind, women and non-white patients were associated with higher rates of device-related complications, longer lengths of stay and higher healthcare costs.
“The ICD trends raise important questions about the underlying causes of these disparities,” co-author Steve Ommen, MD, a cardiologist and medical director of the Mayo Hypertrophic Cardiomyopathy Clinic, said in a prepared statement. “Why are patient outcomes different based on sex and race? Does this reflect an inherent bias, or is it the result of underlying differences in disease expression? As further studies are pursued, providers should seek to eliminate potential bias in ICD decision-making, given the known mortality benefit associated with appropriate ICD implantation.”
"Sudden cardiac death risk stratification and ICD decision-making are pillars of clinical care of patients with HCM,” added senior author Hartzell Schaff, MD, a cardiovascular surgeon at Mayo Clinic. “Despite growing recognition of this disease, the degree of inequity across patient populations was quite surprising.”
In the same statement, Jeffrey Geske, MD, a Mayo Clinic cardiologist, detailed some potential explanations for these findings.
“It is possible that focusing on symptom management shifts focus away from sudden death risk assessment in women more than men, and shared decision-making may result in different choices between sexes,” the authors wrote. “In combination with current findings, these suggest a need for providers to recognize sex-specific differences in outcomes and management trends in women with hypertrophic cardiomyopathy.”
Read the full analysis here.
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.