Women, Blacks Less Likely To Receive Implantable Heart Devices

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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 toprolong life in 31% to 50% of patients who receive them (Maugh, Los Angeles Times, 10/3).

Forone of the studies, Lesley Curtis, an assistant professor of medicineat Duke, and colleagues examined data from a national sample of 237,000Medicare beneficiaries from 1999 through 2005 (USA Today, 10/3). The average age of the beneficiaries was 75 (Los Angeles Times, 10/3). Theresearchers found that 32.3 of 1,000 men and 8.6 of 1,000 women who in2005 met the Medicare coverage criteria to have a defibrillatorimplanted had the device implanted within one year. Black patients were30% less likely than white patients to receive a defibrillator,according to the study.

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

Separate Study

In a separate study, Adrian Hernandez, an assistant professor ofmedicine at Duke, and colleges analyzed data from 13,034 heart failurepatients 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 ventricularejection fraction -- a measure of how well the heart pumps blood -- of30% 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% aslikely and black women were 56% as likely (Los Angeles Times, 10/3).

Comments

The researchers said that there is no medical evidence suggesting thatphysicians consider race or gender when prescribing defibrillators. Inaddition, cost likely was not a factor in Curtis' study since allpatients had the same coverage through Medicare, the researchers said,adding it is possible some patients refused to have a defibrillatorimplanted (Collins, Raleigh News & Observer, 10/3).

Reprinted with permission from kaisernetwork.org. You can view theentire Kaiser WeeklyHealth Disparities Report,search the archives, and sign up for email delivery at kaisernetwork.org/email. The Kaiser Weekly Health Disparities Report is published for kaisernetwork.org, afree service of The Henry J. Kaiser Family Foundation.

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