Geographic, Ethnic and Socioeconomic Factors Influencing Access to Implantable Cardioverter Defibrillators (ICDs) in New Zealand

Wilson, David G.; Harding, Scott; Melton, Iain; Lever, Nigel; Stiles, Martin K.; Boddington, Dean; Heald, S.; Larsen, Peter

doi:10.1016/j.hlc.2012.04.012

Cited by 9 publications

(8 citation statements)

References 10 publications

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“…Our national ICD implant rate of 119 per million in 2016 has increased over time with previous rates of 81 per million in 2010 and 95 per million in 2013 . Our overall ICD implant rate in 2016 is second only to Australia in the Asia‐Pacific region .…”

Section: Discussionmentioning

confidence: 84%

“…The ratio of new primary prevention ICD implants to secondary prevention ICD implants in our cohort was just under 50%. This is essentially unchanged from the last analysis of national ICD implant practice in NZ in 2010 . The primary prevention ICD implant ratio reported in several international registries over the past decade is as follows: 46% in Denmark, 55% in Germany, 57% in the United Kingdom, 59% in Sweden, 62% in Spain, 63% in France, 73% in Canada, 75% in the United States, and 82% in Italy .…”

Section: Discussionmentioning

confidence: 95%

“…Implant volumes and types of pacemakers and ICDs have been surveyed regularly across Australia and NZ previously . In patients who receive ICD and CRT‐D, previous reports have examined the impact of geographic, ethnic, and socioeconomic impact on implant rates at a national level, while the long‐term outcomes of patients have only been examined at a regional level …”

Section: Discussionmentioning

confidence: 99%

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Implantable cardioverter defibrillator and cardiac resynchronization therapy use in New Zealand (ANZACS‐QI 33)

Foo

Lee

Looi

et al. 2019

Journal of Arrhythmia

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on behalf of the ANZACS-QI investigatorsThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractBackground: The ANZACS-QI Cardiac Implanted Device Registry (ANZACS-QI DEVICE) collects nationwide data on cardiac implantable electronic devices in New Zealand (NZ). We used the registry to describe contemporary NZ use of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT). Methods: All ICD and CRT Pacemaker implants recorded in ANZACS-QI DEVICEbetween 1 January 2014 and 31 December 2017 were analyzed. Results:Of 1579 ICD implants, 1152 (73.0%) were new implants, including 49.0% for primary prevention and 51.0% for secondary prevention. In both groups, median age was 62 years and patients were predominantly male (81.4% and 79.2%, respectively).Most patients receiving a primary prevention ICD had a history of clinical heart failure (80.4%), NYHA class II-III symptoms (77.1%) and LVEF ≤35% (96.9%). In the secondary prevention ICD cohort, 88.4% were for sustained ventricular tachycardia or survived cardiac arrest from ventricular arrhythmia. Compared to primary prevention CRT Defibrillators (n = 155), those receiving CRT Pacemakers (n = 175) were older (median age 74 vs 66 years) and more likely to be female (38.3% vs 19.4%). Of the 427 (27.0%) ICD replacements (mean duration 6.3 years), 46.6% had received appropriate device therapy while 17.8% received inappropriate therapy. The ICD implant rate was 119 per million population with regional variation in implant rates, ratio of primary prevention ICD implants, and selection of CRT modality. Conclusion:In contemporary NZ practice three-quarters of ICD implants were new implants, of which half were for primary prevention. The majority met current guideline indications. Patients receiving CRT pacemaker were older and more likely to be female.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Implantable cardioverter defibrillator and cardiac resynchronization therapy use in New Zealand (ANZACS‐QI 33)

Foo

Lee

Looi

et al. 2019

Journal of Arrhythmia

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“…In New Zealand, the Asian population had lower rates of ICD implantation (32/million population) than those of European descent (83/million population). Interestingly, the Maori population in New Zealand had the highest implant rates (114/million population) owing to the substantially greater prevalence of coronary artery disease and heart failure hospitalisation, as well as cardiac risk factors, though this may still represent underuse of ICD therapy 21. Much less is known about other ethnicities and those outside of the USA.…”

Section: Discussionmentioning

confidence: 99%

Disparity in implantable cardioverter defibrillator therapy among minority South Asians in the United Kingdom

Mistry

Vali

Sidhu

et al. 2020

Heart

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ObjectiveThere are large geographical differences in implantable cardioverter defibrillator (ICD) implantation rates for reasons not completely understood. In an increasingly multiethnic population, we sought out to investigate whether ethnicity influenced ICD implantation rates.MethodsThis was a retrospective, cohort study of new ICD implantation or upgrade to ICD from January 2006 to February 2019 in recipients of Caucasian or South Asian ethnicity at a single tertiary centre in the UK. Data were obtained from a routinely collected local registry. Crude rates of ICD implantation were calculated for the population of Leicestershire county and were age-standardised to the UK population using the UK National Census of 2011.ResultsThe Leicestershire population was 980 328 at the time of the Census, of which 761 403 (77.7%) were Caucasian and 155 500 (15.9%) were South Asian. Overall, 2650 ICD implantations were performed in Caucasian (91.9%) and South Asian (8.1%) patients. South Asians were less likely than Caucasians to receive an ICD (risk ratio (RR) 0.43, 95% CI 0.37 to 0.49, p<0.001) even when standardised for age (RR 0.75, 95% CI 0.74 to 0.75, p<0.001). This remained the case for primary prevention indication (age-standardised RR 0.91, 95% CI 0.90 to 0.91, p<0.001), while differences in secondary prevention ICD implants were even greater (age-standardised RR 0.49, 95% CI 0.48 to 0.50, p<0.001).ConclusionDespite a universal and free healthcare system, ICD implantation rates were significantly lower in the South Asian than the Caucasian population residing in the UK. Whether this is due to cultural acceptance or an unbalanced consideration is unclear.

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“…It is often measured as a combination of education, income, and occupation. SES is a key factor in determining quality of life for women and a known determinant of poor outcomes and a lack of access to evidence‐based treatment in heart failure patients. Similarly, living in a rural setting has been associated with poorer health and a decrease in uptake of heart failure therapies …”

Section: Introductionmentioning

confidence: 99%

Impact of sex, socio‐economic status, and remoteness on therapy and survival in heart failure

et al. 2019

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Aims This study aims to determine if traditional markers of disadvantage [female sex, low socio-economic status (SES), and remoteness] are associated with lower prescription of evidence-based therapy and higher mortality among patients with moderate-severe heart failure with reduced ejection fraction. Methods and resultsWe recruited 452 consecutive class II-III heart failure with reduced ejection fraction patients. Baseline clinical data were recorded prospectively. The primary outcome was the association of female sex on overall survival. Secondary outcomes included association between evidence-based therapy delivery and sex and association of SES and remoteness on heart failure therapy and survival. The Australian Bureau of Statistics generated all indices. Median follow-up was 37.9 months. One hundred and nine patients (24.3%) were women. There was no difference in overall survival based on sex (hazard ratio = 1.19, 95% confidence interval: 0.74-1.92, 0.48). There was no difference in prescription of beta-blockers [χ 2 (1) = 0.91, 0.66], angiotensin-converting enzyme inhibitors [χ 2 (1) = 0.001, 0.97], nor aldosterone antagonists [χ 2 (1) = 2.71, 0.10]. There was no difference in rates of primary prevention implantable cardioverter-defibrillator implantation in men compared with women [χ 2 (1) = 0.35, 0.56]. Neither higher SES nor inner city residence conferred an overall survival benefit. Conclusions In this Australian cohort of heart failure patients, delivery of care and likelihood of death are comparable between the sexes, SES groups, and rural vs. city residents.

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Geographic, Ethnic and Socioeconomic Factors Influencing Access to Implantable Cardioverter Defibrillators (ICDs) in New Zealand

Cited by 9 publications

References 10 publications

Implantable cardioverter defibrillator and cardiac resynchronization therapy use in New Zealand (ANZACS‐QI 33)

Implantable cardioverter defibrillator and cardiac resynchronization therapy use in New Zealand (ANZACS‐QI 33)

Disparity in implantable cardioverter defibrillator therapy among minority South Asians in the United Kingdom

Impact of sex, socio‐economic status, and remoteness on therapy and survival in heart failure

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