In nonischemic cardiomyopathy requiring ICD, Black patients may have worse outcomes
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Key takeaways:
- In certain patients with an ICD for primary prevention, Black patients had worse outcomes than white patients.
- The differences were observed in nonischemic cardiomyopathy but not in ischemic cardiomyopathy.
In patients with an implantable cardioverter defibrillator for primary prevention, among those with nonischemic cardiomyopathy, Black patients were more likely to have arrhythmias, to receive ICD therapies and to die than white patients.
However, in patients with ischemic cardiomyopathy who had an ICD for primary prevention, there were no differences by race in arrhythmias, ICD therapies and survival, researchers reported in Circulation.
“We believe the main implication of this study is that because we now know that Black patients who have heart failure are more likely to have more advanced arrhythmias, they should be considered earlier for an ICD defibrillator to protect them from sudden cardiac death,” Ilan Goldenberg, MD, professor of medicine and director of the Clinical Cardiovascular Research Center at the University of Rochester Medical Center, said in a press release.
Goldenberg and colleagues analyzed 3,895 U.S. patients with cardiomyopathy who were enrolled in primary prevention ICD trials. Patients were stratified by cardiomyopathy type and by race and were followed for a mean of 3 years.
Outcomes of interest included ventricular tachyarrhythmia (VTA), atrial tachyarrhythmia (ATA), ICD therapies (appropriate and inappropriate), VTA burden and death.
Compared with white patients, Black patients were more likely to be women (35% vs. 22%), younger (57 years vs. 62 years) and had more comorbidities, the researchers wrote.
In patients with nonischemic cardiomyopathy, compared with white patients, Black patients had higher rates of the following:
- First VTA, defined as at least 170 bpm (32% vs. 20%);
- Fast VTA, defined as at least 200 bpm (22% vs. 14%);
- ATA (25% vs. 12%);
- Appropriate ICD therapy (30% vs. 20%); and
- Inappropriate ICD therapy (25% vs. 11%; P for all < .001).
In a multivariate analysis of patients with nonischemic cardiomyopathy, compared with white patients, Black patients had higher risk for first VTA (HR = 1.71; P < .01), fast VTA (HR = 1.58; P < .01), ATA (HR = 1.87; P < .01), appropriate ICD therapy (HR = 1.62; P < .01), inappropriate ICD therapy (HR = 1.86; P < .01), VTA burden (HR = 1.84; P < .001), appropriate therapy burden (HR = 1.84; P < .001) and death (HR = 1.92; P = .014), the researchers wrote.
However, in patients with ischemic cardiomyopathy, there were no differences in any of the outcomes of interest, and the researchers were unsure as to why the results were different between ischemic cardiomyopathy and nonischemic cardiomyopathy.
“It is possible that Black patients are not managed as well as white patients because of health care disparities, but we did not identify any significant differences in our study,” Goldenberg said in the release. “We did identify that after 1 year, Black patients were more likely to discontinue some medications, but the reasons for that are unknown as well. The younger age of onset and the increased rate of comorbidities, such as diabetes and hypertension, among Black patients with [nonischemic cardiomyopathy] is striking and may contribute to the worse outcomes due to more advanced heart disease.”
Reference:
- University of Rochester Medical Center. www.urmc.rochester.edu/news/story/racial-disparities-discovered-in-patients-with-implantable-cardiac-devices. Published July 17, 2023. Accessed July 17, 2023.
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