27 Jan Racial Disparities in Use of Cardiac Resynchronization Therapy With ICD
MedicalResearch.com Interview with:
Dr. Lucas Marzec
Lucas Marzec MD
Instructor of Medicine
Section of Cardiac Electrophysiology
Division of Cardiology
University of Colorado School of Medicine
Aurora, CO 80045
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The addition of cardiac resynchronization therapy (CRT) to an implantable cardioverter defibrillator (ICD) reduces the risk of mortality and heart failure events in select patients with left ventricular systolic dysfunction. Given these benefits, it is important to ensure patients who have a guideline recommendation for CRT are considered for this therapy at the time of ICD implantation. Previously, little data were available on the contemporary use of CRT among guideline eligible patients undergoing ICD implantation.
Although ICDs alone reduce the risk of mortality in patients with heart failure and reduced systolic function, prior work shows these devices are not uniformly provided to eligible patients and that rates of ICD implantation vary widely by hospital. Prior to our study, it was unknown whether similar variation in the use of the combination of ICD and CRT (CRT-D) exists.
We analyzed data from the National Cardiovascular Data Registry (NCDR) ICD Registry to identify patient, provider, and hospital characteristics associated with CRT-D use and to determine the extent of hospital level variation in the use of CRT-D among patients eligible for CRT undergoing implantation of an ICD.
MedicalResearch.com: What should readers take away from your report?
Response: In a national cohort of patients eligible for CRT-D at the time of ICD implantation, we found black patients and those with non-private insurance were less likely to receive CRT-D while patients treated by higher volume operators and electrophysiology trained providers were more likely to receive CRT-D.
After consideration of patient, provider, and hospital factors, we observed wide hospital level variation in the use of CRT-D in guideline eligible patients.
Our results suggest an important treatment gap exists regarding CRT-D devices.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future work should address strategies to reduce the disparities we observed in the use of CRT-D and to improve rates of CRT-D use at sites with low rates of CRT-D implantation in eligible patients. These efforts may improve clinical outcomes for patients through an increased use of CRT-D in patients strong guideline-based recommendations for use.
There are no disclosures.
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Last Updated on January 27, 2017 by Marie Benz MD FAAD