Gender, Racial, and Health Insurance Differences in the Trend of Implantable Cardioverter‐Defibrillator (<scp>ICD</scp>) Utilization: A United States Experience Over the Last Decade

Patel, Nileshkumar; Edla, Sushruth; Deshmukh, Abhishek; Nalluri, Nikhil; Patel, Nilay; Agnihotri, Kanishk; Patel, Achint; Savani, Chirag; Patel, Nish; Bhimani, Ronak; Thakkar, Badal; Arora, Shilpkumar; Asti, Deepak; Badheka, Apurva; Parikh, Valay; Mitrani, Raul D.; Noseworthy, Peter A.; Paydak, Hakan; Viles-González, Juan F.; Friedman, Paul A.; Kowalski, Marcin

doi:10.1002/clc.22496

Cited by 64 publications

(42 citation statements)

References 25 publications

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“…While white beneficiaries were much more likely to receive HD, all non-white subpopulations, including Asians who enjoy comparable IIV uptake, were much less likely to receive HD versus SD, as were beneficiaries with a Part D subsidy or residing in a rural region, populations arguably in more need of this more protective intervention. These results comport with well-documented disparities in dissemination of medical innovation reflecting multiple results [22][23][24][25][26]. Several factors correlated with higher IIV uptake, including having one or more comorbidities, ambulatory physician visits, or part D prescriptions, and having received a pneumonia vaccine, as has been previously observed [27].…”

Section: Discussionsupporting

confidence: 77%

A Map of Racial and Ethnic Disparities in Influenza Vaccine Uptake in the Medicare Fee-for-Service Program

Hall

Mahmud

et al. 2020

Adv Ther

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Introduction: Despite improved understanding of the risks of influenza and better vaccines for older patients, influenza vaccination rates remain subpar, including in high-risk groups such as older adults, and demonstrate significant racial and ethnic disparities. Methods: This study considers demographic, clinical, and geographic correlates of influenza vaccination among Medicare Fee-for-Service (FFS) beneficiaries in 2015-2016 and maps the data on a geographic information system (GIS) at the zip code level. Results: Analyses confirm that only half of the senior beneficiaries evidenced a claim for receiving an inactivated influenza vaccine (IIV), with significant disparities observed among black, Hispanic, rural, and poorer beneficiaries. More extensive disparities were observed for the high-dose (HD) vaccine, with its added protection for older populations and confirmed economic benefit. Most white beneficiaries received HD; no non-white subgroup did so. Mapping of the data confirmed subpar vaccination in vulnerable populations with wide variations at the zip code level. Conclusion: Urgent and targeted efforts are needed to equitably increase IIV rates, thus protecting the most vulnerable populations from the negative health impact of influenza as well as the tax-paying public from the Medicare costs from failing to do so.

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Section: Discussionsupporting

confidence: 77%

A Map of Racial and Ethnic Disparities in Influenza Vaccine Uptake in the Medicare Fee-for-Service Program

Hall

Mahmud

et al. 2020

Adv Ther

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“…The ratio for ICDs between both genders is even 4:1 in favour of male patients and the ratio equally persists in all five investigated countries. Similarly, surprising results regarding the gender differences have also been found in previous large-scale studies (8,9). The authors of these studies claim that observed gender disparities could not be attributable to different heart failure prevalence across gender, different proportions of male and female subgroups in study samples, or to any other similar contextual factors, which might indicate that cardiologists adhere to different standards and/or guidelines while treating either male or female patients.…”

Section: Discussionmentioning

confidence: 65%

Causes of differences in the uptake of cardiac implantation electronic devices in Slovenia in comparison to other countries

Rupel

Slabe‐Erker

Divjak

2018

Slovenian Journal of Public Health

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Introduction:The purpose of this study is to analyse and present the causes of the differences in crude utilization rate in cardiac implantation electronic devices, specifically pacemakers and automatic implantable cardioverter-defibrillators, across 5 European countries, with a specific emphasis on Slovenia.Methods: Based on the results of the analysis of the uptake of cardiac implantation electronic devices across countries studied in MedtecHTA project, the targeted interviews were conducted to explain the factors that impact the differences and explain data in Slovenia. Results:The reasons for the differences in crude utilization rate across 5 European countries were multiple: the first group of differences refers to the coding system and linkages between coding and financing of health care. The second group of reasons can be qualitatively ascribed to the economic situation, financial situation in health care, and its impact on decision-making. The last reason is the non-existence of the golden rule for optimal crude utilisation rate. Conclusions:It is evident that the differences in the uptake of cardiac implantation electronic devices among the countries are of organisational nature: they refer to the system of coding, the importance attached to correct coding practices, the link between coding and financing of health care as well as the availability of private clinics and private insurance. According to the interviews, the economic development of the country also impacts those differences,whereas the differences in clinical practice and guidelines are claimed not to play a role in the explanation of the differences. Prevolnik Rupel V, Erker R, Divjak M. Causes of differences in the uptake of cardiac implantation electronic devices in Slovenia in comparison to other countries.

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“…2 For example, ICD utilization in the United States has been reported to be 280 per million, in comparison to 4.3 per million in China and 3.1 per million in India. 3,4 Risk factors known to represent the severity of ventricular dysfunction and thus increase the risk of SCD include syncope or presyncope, [5][6][7] low ventricular ejection fraction (LVEF, ,25%), 8 nonsustained ventricular tachycardia (NSVT), [9][10][11] and frequent premature ventricular contractions (PVCs, 10/h). 12,13 In a retrospective analysis of the OMNI study, Assessing Therapies in Medtronic Pacemaker, Defibrillator and Cardiac Resynchronization Therapy Devices (ClinicalTrials.gov ID: NCT00277524), a subset of patients with PP indications with at least 1 of these risk factors had a similar rate of ventricular tachyarrhythmias (ventricular tachycardia or fibrillation [VT/VF]) as patients receiving ICDs for SP.…”

Section: Introductionmentioning

confidence: 99%

Utilization of implantable cardioverter-defibrillators for the prevention of sudden cardiac death in emerging countries: Improve SCA clinical trial

et al. 2020

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BACKGROUND Implantable cardioverter-defibrillators (ICDs) are underutilized in Asia, Latin America, Eastern Europe, the Middle East, and Africa. The Improve SCA Study is the largest prospective study to evaluate the benefit of ICD therapy in underrepresented geographies. This analysis reports the primary objective of the study. OBJECTIVES The objectives of this study was to determine whether patients with primary prevention (PP) indications with specific risk factors (1.5PP: syncope, nonsustained ventricular tachycardia, premature ventricular contractions .10/h, and low ventricular ejection fraction ,25%) are at a similar risk of life-threatening arrhythmias as patients with secondary prevention (SP) indications and to evaluate all-cause mortality rates in 1.5PP patients with and without devices. METHODS A total of 3889 patients were included in the analysis to evaluate ventricular tachycardia or fibrillation therapy and mortality rates. Patients were stratified as SP (n 5 1193) and patients with PP indications. The PP cohort was divided into 1.5PP patients (n 5 1913) and those without any 1.5PP criteria (n 5 783). The decision to undergo ICD implantation was left to the patient and/ or physician. The Cox proportional hazards model was used to compute hazard ratios. RESULTS Patients had predominantly nonischemic cardiomyopathy. The rate of ventricular tachycardia or fibrillation in 1.5PP patients was not equivalent (within 30%) to that in patients with SP indications (hazard ratio 0.47; 95% confidence interval 0.38-0.57) but was higher than that in PP patients without any 1.5PP criteria (hazard ratio 0.67; 95% confidence interval 0.46-0.97) (P 5 .03). There was a 49% relative risk reduction in all-cause mortality in ICD implanted 1.5PP patients. In addition, the number needed to treat to save 1 life over 3 years was 10.0 in the 1.5PP cohort vs 40.0 in PP patients without any 1.5PP criteria. CONCLUSION These data corroborate the mortality benefit of ICD therapy and support extension to a selected PP population from underrepresented geographies.

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Gender, Racial, and Health Insurance Differences in the Trend of Implantable Cardioverter‐Defibrillator (ICD) Utilization: A United States Experience Over the Last Decade

Cited by 64 publications

References 25 publications

A Map of Racial and Ethnic Disparities in Influenza Vaccine Uptake in the Medicare Fee-for-Service Program

A Map of Racial and Ethnic Disparities in Influenza Vaccine Uptake in the Medicare Fee-for-Service Program

Causes of differences in the uptake of cardiac implantation electronic devices in Slovenia in comparison to other countries

Utilization of implantable cardioverter-defibrillators for the prevention of sudden cardiac death in emerging countries: Improve SCA clinical trial

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