ICD Gap for Women, African-Americans

Oct. 2, 2007 -- Women are two to three times less likely -- and African-Americans are 25% less likely -- than white men to get defibrillator implants when they need them.

The implants, known as implantable cardioverter defibrillators or ICDs, detect when a heart goes into a life-threatening abnormal heart rhythm. Via leads that reach into the heart, the ICDs then deliver a lifesaving electric shock to restore normal heart rhythm.

The devices are definitely supposed to be given to prevent sudden death in patients with previous attacks of these types of abnormal heart rhythms. This is called secondary prevention -- that is, preventing a second attack.

The American Heart Association also suggests that doctors consider giving the devices to patients who haven't yet had life-threatening heart-rhythm problems but are at high risk of dying from one. This is called primary prevention -- preventing a first attack.

The new findings come from two studies appearing in the Oct. 3 issue of TheJournal of the American Medical Association. Between them, the studies show that three groups -- black women, all women, and black men -- get fewer ICDs. This is true even when the researchers compared people with the same medical conditions, the same age, and the same insurance coverage.

Who Is Getting an ICD?

In the first study, Lesley H. Curtis, PhD, assistant professor of medicine at Duke University in Durham, N.C., and colleagues analyzed data on more than 230,000 Medicare patients at risk of sudden heart death. All patients were treated from 1999 through 2005.

Curtis and colleagues found that men were three times more likely to get an ICD for primary prevention than women were. For secondary prevention (preventing a second life-threatening episode), men were nearly two-and-a-half times more likely to get an ICD.

In the second study, Duke cardiologist Adrian F. Hernandez, MD, MHS, and colleagues used data from an ongoing study collecting data on more than 13,000 U.S. heart patients who should have received an ICD according to current guidelines. All of these patients already had a diagnosis of heart failure, and their hearts were very inefficient at pumping blood.

Overall, the researchers found that only 35% of patients who should have received an ICD actually got one. But some patients were even less likely to get an ICD than others:

• Black women were 44% less likely to get an ICD than were white men.
• White women were 38% less likely to get an ICD than were white men.
• Black men were 27% less likely to get an ICD than were white men.

"I wish I knew what is going on. I really do," Curtis tells WebMD. "In a doctor's mind, is the face of a patient at risk of sudden cardiac death a white male? We don't know. There may be misperceptions about the risk in women. Or this may reflect that women and minorities have more difficulty navigating the health care system. Maybe they just are not being seen by the doctors that might recommend these devices."