Cardiovascular Implantable Electronic Devices -> Tachycardia Devices: -> Indications D-AB21 - Real World Outcomes of Patients with an ICD (ID 7) Abstract

D-AB21-05 - Does Consultation With An Electrophysiologist Impact Disparities In Implantable Cardioverter Defibrillator Use By Sex And Race? (ID 790)


Background: Disparities in the use of implantable cardioverter defibrillators (ICD) by race and sex have been widely reported. In the US, most ICDs are implanted by electrophysiologists (EP). The impact of EP consultations with race and sex differences in ICD use in the US are less well studied.
Objective: To examine ICD use and EP consultation by race and sex in newly ICD-indicated patients using electronic health records (EHR).
Methods: Records from 2.9 million US patients from the Optum® de-identified EHR dataset with cardiac disease, arrhythmia or syncope were screened. Included patients had new Class 1 or 2a guideline indications for ICDs, had >1 year of prior records with no ICD, were age <79 years and had no exclusions. EP visits included office, consult and diagnostic imaging encounters. Differences in EP visits and ICD use by group controlled for age, left ventricular ejection fraction and QRS width.
Results: Among 58,896 women and 100,203 men, 51.2% and 54.7% (p < 0.001) had seen an EP (Table). In patients with EP visits, ICD use was lower in women than men (23.0% vs. 28.1%, p < 0.001). While a larger proportion of white patients had EP visits, ICD use among these patients was lower (25.9%, p = 0.005). In patients of other races with EP visits, differences in ICD use were not significant. In 74,156 ICD-indicated patients not seen by an EP, ICD use was only 3.4%; differences by sex and race were small and not significant.
Conclusion: This large sample of real-world data showed significant disparities in EP visits by sex and race. ICD use disparities by race suggest potential bias in care pathways to EPs, but not implant decisions. Sex disparities appear in both access and treatment decisions by EPs.