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Black, Hispanic patients less likely to receive treatment for advanced HF
Black and Hispanic patients met eligibility criteria more often than white patients in registry review.
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Black and Hispanic patients eligible for cardiac resynchronization therapy with a defibrillator were less likely to receive the therapy than white patients.
In the national study of 108,341 participants in more than 1,000 hospitals enrolled in the National Cardiovascular Data Registry from January 2005 to April 2007, researchers found that minority patients were also more likely to meet the criteria for CRT defibrillator therapy than white patients. White patients were also more likely to receive the therapy outside of published guidelines.
The researchers conducted two analyses to find out the outcomes of patients who received either an ICD or CRT defibrillator, and to find out who received CRT defibrillator therapy outside of published guidelines. They found that 22,205 patients met guidelines to receive an ICD or CRT defibrillator but that 27,165 patients received CRT defibrillator therapy.
The results showed that eligible black patients (OR=0.84; 95% CI, 0.75-0.95) and Hispanic patients (OR=0.83; 95% CI, 0.71-0.99) were not as likely as white patients to receive CRT defibrillator therapy. Also a large portion of patients received CRT defibrillator therapy outside of published guidelines but black patients (OR=1.18; 95% CI, 1.02-1.36) and Hispanic patients (OR=1.17; 95% CI, 1.02-1.36) were more likely to qualify based on eligibility criteria.
“These findings suggest an important opportunity to improve care by expanding access to CRT defibrillator therapy for eligible minority patients,” the researchers concluded.
Farmer SA. Heart Rhythm J. 2009;6:325-331
This is a troublesome issue and data such as these have been noted in many other areas including revascularization therapy and reperfusion for STEMI, etc. The issues are complex and the explanations are likely multifactorial but in general, socio-economic status is strongly correlated with care received and outcomes. I believe that physicians do not discriminate on the basis of age, sex and socio-economic status, but the latter may be related to the type of hospital and facilities that are used by the patient, compliance, reluctance to accept invasive therapies, access to tertiary care facilities and insurance coverage. In some situations, there may be a much higher incidence of co-morbidities which could limit the potential benefits of procedures. This is certainly an area that requires attention and applies to all countries. A recent study of patients with angina in the United Kingdom demonstrated that socially-deprived patients and South Asians were less likely to undergo angiography (Sekhri N. BMJ. 2008;336:1058-1061). Wealth is associated with better health, even in single-payer systems.
– Bernard Gersh, MB, ChB, DPhil
Cardiology Today Editorial Board member