Women, Blacks Less Likely Than White Men To Receive Implantable Heart Devices, Studies Say

Main Category: Medical Devices / Diagnostics
Also Included In: Cardiovascular / Cardiology;  Women's Health / Gynecology
Article Date: 04 Oct 2007 - 6:00 PDT

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Women and blacks are less likely than white men to receive implantable cardiac defibrillators, according to two studies led by Duke University researchers and published Wednesday in the Journal of the American Medical Association, the Wall Street Journal reports.

Defibrillators are designed to deliver electrical pulses to help a heart beat properly, according to the Journal (Corbett Dooren, Wall Street Journal, 10/3). Medicare coverage for implantable defibrillators expanded in late 2004, USA Today reports (Rubin, USA Today, 10/3). According to the Los Angeles Times, the devices cost about $30,000 to $40,000 and have been shown to prolong life in 31% to 50% of patients who receive them (Maugh, Los Angeles Times, 10/3).

For one of the studies, Lesley Curtis, an assistant professor of medicine at Duke, and colleagues examined data from a national sample of 237,000 Medicare beneficiaries from 1999 through 2005 (USA Today, 10/3). The average age of the beneficiaries was 75 (Los Angeles Times, 10/3). The researchers found that 32.3 of 1,000 men and 8.6 of 1,000 women who in 2005 met the Medicare coverage criteria to have a defibrillator implanted had the device implanted within one year. Black patients were 30% less likely than white patients to receive a defibrillator, according to the study.

In addition, the study found that among beneficiaries who previously had experienced a cardiac event, men were about 2.5 times more likely than women to receive a defibrillator within one year (USA Today, 10/3). Among those who already had experienced a cardiac event, 102.2 of every 1,000 men and 38.4 of every 1,000 women received a defibrillator. The risk of death in the year following implantation was 35% lower among those who received the device, the study found (Los Angeles Times, 10/3).

Separate Study
In a separate study, Adrian Hernandez, an assistant professor of medicine at Duke, and colleges analyzed data from 13,034 heart failure patients who were admitted to 217 hospitals in the American Heart Association's "Get With the Guidelines: Heart Failure" program between January 2005 and June 2007 (USA Today, 10/3). The researchers looked at patients who had left ventricular ejection fraction -- a measure of how well the heart pumps blood -- of 30% or less (Wall Street Journal, 10/3). The normal ejection fraction for the left ventricle is 55% to 70%, USA Today reports (USA Today, 10/3).

The study found that 35.4% of eligible patients had received a defibrillator or had plans for one to be implanted (Wall Street Journal, 10/3). In addition, the study said that in comparison to white men, black men were 73% as likely to receive an ICD, white women were 62% as likely and black women were 56% as likely (Los Angeles Times, 10/3).

Comments
Kevin Schulman, an internist and health policy expert at Duke who worked on Curtis' study, said that it is unclear why the "difference exists" but added that it "is bad news for women." Curtis said that the "sex difference in treatment rates is really worrisome" (Los Angeles Times, 10/3). The researchers said that there is no medical evidence suggesting that physicians consider race or gender when prescribing defibrillators. In addition, cost likely was not a factor in Curtis' study since all patients had the same coverage through Medicare, the researchers said, adding it is possible some patients refused to have a defibrillator implanted.

Jay Kaufman -- an epidemiologist at the University of North Carolina-Chapel Hill, who was not involved with either study -- said that women might not be as aggressive as men in seeking treatment for heart problems. "A lot of women just kind of ignore the symptoms because they're so busy taking care of everyone else in their lives," Sloan Garner, a spokesperson for the Morrisville, N.C., office of the AHA, said, adding, "They think heart disease is a man's disease" (Collins, Raleigh News & Observer, 10/3).

The first study is available online.

An abstract of the second study is available online.

ABC's "World News" on Monday reported on the study. The segment includes comments from Sharonne Hayes of the Mayo Clinic and Holly Andersen of New York-Presbyterian Hospital (McKenzie, "World News," ABC, 10/2). A partial transcript of the segment is available online. A video excerpt of Hayes' comments is available online.

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