Saguaro
10-02-2007, 09:10 PM
Clinical trials have shown that implantable cardioverter defibrillators can save people at risk for sudden cardiac death. The leading organizations of doctors who treat such patients have set guidelines for their use, and Medicare and health plans cover most of their cost.
Yet women are far less likely to receive the devices than men, and black patients overall are less likely to receive them than white patients, two studies report Wednesday.
The research is the latest in a series of studies highlighting gender and race disparities in health care in general and treatment of heart disease in particular.
"It's frustrating," says Lesley Curtis, lead author of one study and co-author of another. "I'd love to be delivering good news for women, but not yet, not yet."
In the study on which Curtis is lead author, researchers analyzed data from a national sample of 237,000 Medicare patients from 1999 through 2005. In late 2004, Medicare greatly expanded coverage of implantable defibrillators for primary prevention of sudden cardiac death in patients who have had a heart attack and have either cardiomyopathy or heart failure.
Among patients in 2005 who met that criteria, 32.3 out of 1,000 men received a defibrillator within one year of diagnosis, while only 8.6 out of 1,000 women did — a more than threefold difference, Curtis, an assistant professor of medicine at Duke University, and her co-authors found.
Among secondary prevention patients, those who'd had a prior diagnosis of cardiac arrest or a life-threatening irregular heart rhythm called ventricular tachycardia, men in 2005 were about 2½ times more likely to receive a defibrillator within a year of diagnosis, Curtis' team reports in The Journal of the American Medical Association.
Black patients in both prevention groups were 30% less likely than white patients to get the device, they found.
In the other study, researchers analyzed 13,034 heart failure patients admitted to 217 hospitals in the American Heart Association's voluntary "Get With the Guidelines: Heart Failure" quality-improvement program. They were treated between January 2005 and last June.
Unlike Medicare claims, the Get With the Guidelines data include patient-specific information about a measurement called the ejection fraction, which refers to the heart's pumping capacity. The normal ejection fraction for the left ventricle, the heart's main pumping chamber, is 55% to 70%. Medicare covers implantable defibrillators for heart failure patients whose ejection fraction is below 35%. The study focused on those below 30%.
Yet, even among such sick patients, fewer than 40% got the device. About 44% of eligible white men got one, compared with only 30% of white women. Among eligible black patients, only about 33.5% of men and 28% of women got one.
Patients need to become informed consumers, says lead author Adrian Hernandez, an assistant professor of medicine at Duke. "Patients have the greatest investment in their own health, and, therefore, will have the greatest benefit if they understand more about what needs to be done."
UCLA cardiologist Gregg Fonarow, chair of the Get With the Guidelines steering committee, notes that much research has suggested it takes at least 10 years for doctors to widely adopt treatment guidelines. The American College of Cardiology/AHA guidelines regarding implantable defibrillators came out in August 2005, the Heart Failure Society of America's in January 2006.
The new studies are among the first to show underuse and disparities in the use of implantable defibrillators, Fonarow says. The findings, he says, "can be an important call to action."
http://www.usatoday.com/news/health/2007-10-02-defibrillators-study_N.htm?csp=1
Yet women are far less likely to receive the devices than men, and black patients overall are less likely to receive them than white patients, two studies report Wednesday.
The research is the latest in a series of studies highlighting gender and race disparities in health care in general and treatment of heart disease in particular.
"It's frustrating," says Lesley Curtis, lead author of one study and co-author of another. "I'd love to be delivering good news for women, but not yet, not yet."
In the study on which Curtis is lead author, researchers analyzed data from a national sample of 237,000 Medicare patients from 1999 through 2005. In late 2004, Medicare greatly expanded coverage of implantable defibrillators for primary prevention of sudden cardiac death in patients who have had a heart attack and have either cardiomyopathy or heart failure.
Among patients in 2005 who met that criteria, 32.3 out of 1,000 men received a defibrillator within one year of diagnosis, while only 8.6 out of 1,000 women did — a more than threefold difference, Curtis, an assistant professor of medicine at Duke University, and her co-authors found.
Among secondary prevention patients, those who'd had a prior diagnosis of cardiac arrest or a life-threatening irregular heart rhythm called ventricular tachycardia, men in 2005 were about 2½ times more likely to receive a defibrillator within a year of diagnosis, Curtis' team reports in The Journal of the American Medical Association.
Black patients in both prevention groups were 30% less likely than white patients to get the device, they found.
In the other study, researchers analyzed 13,034 heart failure patients admitted to 217 hospitals in the American Heart Association's voluntary "Get With the Guidelines: Heart Failure" quality-improvement program. They were treated between January 2005 and last June.
Unlike Medicare claims, the Get With the Guidelines data include patient-specific information about a measurement called the ejection fraction, which refers to the heart's pumping capacity. The normal ejection fraction for the left ventricle, the heart's main pumping chamber, is 55% to 70%. Medicare covers implantable defibrillators for heart failure patients whose ejection fraction is below 35%. The study focused on those below 30%.
Yet, even among such sick patients, fewer than 40% got the device. About 44% of eligible white men got one, compared with only 30% of white women. Among eligible black patients, only about 33.5% of men and 28% of women got one.
Patients need to become informed consumers, says lead author Adrian Hernandez, an assistant professor of medicine at Duke. "Patients have the greatest investment in their own health, and, therefore, will have the greatest benefit if they understand more about what needs to be done."
UCLA cardiologist Gregg Fonarow, chair of the Get With the Guidelines steering committee, notes that much research has suggested it takes at least 10 years for doctors to widely adopt treatment guidelines. The American College of Cardiology/AHA guidelines regarding implantable defibrillators came out in August 2005, the Heart Failure Society of America's in January 2006.
The new studies are among the first to show underuse and disparities in the use of implantable defibrillators, Fonarow says. The findings, he says, "can be an important call to action."
http://www.usatoday.com/news/health/2007-10-02-defibrillators-study_N.htm?csp=1