Racial and ethnic differences in implantable cardioverter-defibrillator patient selection, management, and outcomes

Kiernan, Katherine; Dodge, Shayne E.; Kwaku, Kevin F.; Jackson, Larry R.; Zeitler, Emily P.

doi:10.1016/j.hroo.2022.09.003

Cited by 10 publications

(10 citation statements)

References 74 publications

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“…9 Similar findings have been found for other cardiovascular procedures including mitral valve replacement, and implantation of implantable cardioverter-defibrillators. 6,8,9 There is a pressing need to increase enrollment of minority patients into clinical trials either by way of mandated enrollment targets, broadening the clinical trial sites to include hospitals serving predominantly racial and ethnic minoritized patients and including investigators who also serve this patient population in clinical trials.…”

Section: Discussionmentioning

confidence: 99%

“…5 Racial and ethnic minority individuals have also been consistently shown to be undertreated in terms of other cardiovascular procedures like transcatheter aortic valve replacement (TAVR), mitral valve replacement, and implantation of implantable cardioverter-defibrillators. [6][7][8][9] In published clinical trials and real-world experience with transcatheter LAAO, non-Hispanic White patients have represented over 90% of cases; it is not clear that the efficacy in the overall population is generalizable to all racial and ethnic groups. Studies of racial and ethnic disparities in transcatheter LAAO outcomes have shown higher rates of in-hospital complications among non-Hispanic Black and Hispanic patients compared to non-Hispanic White patients.…”

Section: Introductionmentioning

confidence: 99%

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Racial and Ethnic Disparities in the Utilization and Outcomes with WATCHMAN FLX: A SURPASS analysis of the NCDR LAAO Registry

Alli,

Garg,

Boursiquot

et al. 2024

Preprint

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Background: Left atrial appendage occlusion (LAAO) is increasingly used as an alternative to oral anticoagulation for stroke prevention in select patients with atrial fibrillation. Data on outcomes in racial and ethnic minority individuals are limited. This analysis assessed differences in the utilization and outcomes of LAAO by race and ethnicity in a large national registry. Methods: This analysis acquired data on WATCHMAN FLX patients from the National Cardiovascular Data Registry (NCDR) LAAO Registry through September 2022. All patients with an attempted WATCHMAN FLX implantation and known race and ethnicity were included. Baseline characteristics and 1 year event rates were compared. Results: A total of 97,185 patients were analyzed; 87,339 were White (90%), 3,750 Black (Black/African American 3.9%), and 2,866 Hispanic ([Hispanic/Latinx] 2.9%). Black and Hispanic patients were younger with a higher incidence of prior stroke and significant bleeding compared to White patients. Black and Hispanic patients were treated with LAAO in smaller numbers relative to their proportion of the US population. Rates of procedural success were similar between groups. Though direct oral anticoagulants were prescribed in most patients across the groups, dual and single antiplatelet therapy were prescribed more often in Black patients. Black patients had significantly higher rates of 1-year death and bleeding compared to White and Hispanic patients. Conclusions: Patients from racial and ethnic minority groups comprise a disproportionately small fraction of all patients who undergo LAAO. Black and Hispanic patients were younger but had significantly higher comorbidities compared to White patients. Procedural success was similar amongst the groups but Black patients experienced higher rates of death and bleeding at 1 year.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Racial and Ethnic Disparities in the Utilization and Outcomes with WATCHMAN FLX: A SURPASS analysis of the NCDR LAAO Registry

Alli,

Garg,

Boursiquot

et al. 2024

Preprint

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“…A review by Kiernan et al highlighted the disproportionate effect of SCD disease burden in non-Caucasian identifying populations and racial and ethnic differences in the efficacy of implantable cardioverter-defibrillators in these groups. 30 In a retrospective postmortem study on sudden explained deaths, Lin et al utilized high-resolution variant classification in cardiac arrhythmogenic gene testing within a diverse cohort. 31 The study found that 3.1% of the Hispanic subjects tested positive for pathogenic or likely pathogenic arrhythmogenic genetic variants.…”

Section: Genetic Studies In Hispanic/latino Populationsmentioning

confidence: 99%

Arrhythmias and Ion Channelopathies Causing Sudden Cardiac Death in Hispanic/Latino and Indigenous Populations

Boutjdir,

Zaveri,

Chahine

2024

Preprint

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The limited literature and increasing interest in studies on cardiac electrophysiology, explicitly focusing on cardiac ion channelopathies and sudden cardiac death (SCD) in diverse populations, has prompted a comprehensive examination of existing research. Our review specifically targets Hispanic/Latino and Indigenous populations, which are often underrepresented in healthcare studies. This review encompasses investigations into genetic variants, epidemiology, etiologies, and clinical risk factors associated with arrhythmias in these demographic groups. The review explores the Hispanic paradox, a phenomenon linking healthcare outcomes to socioeconomic factors within Hispanic communities in the United States. Furthermore, it discusses studies exemplifying this observation in the context of arrhythmias and ion channelopathies in Hispanic populations. Current research also sheds light on disparities in overall healthcare quality in Indigenous populations. The available yet limited literature underscores the pressing need for more extensive and comprehensive research on cardiac ion channelopathies in Hispanic/Latino and Indigenous populations. Specifically, additional studies are essential to fully characterize pathogenic genetic variants, identify population-specific risk factors, and address health disparities to enhance the detection, prevention, and management of arrhythmias and SCD in these demographic groups.

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“…In a multinational European registry study on primary prevention ICD, fewer women than men undergo ICD implantation; however, women also have lower mortality and receive fewer appropriate ICD shocks after multivariate adjustment [67] . In a race-based subanalysis of the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT, NCT00000609) on primary prevention ICD for LVEF ≤ 35% in ICM and non-ischemic cardiomyopathy, survival benefits conferred by ICD was independent of race [68] . Furthermore, the incidence of ICD refusal and medication non-compliance were comparable between Black and Caucasian patients [68] , suggesting that the lower rates of specialist consultation and ICD implantation in eligible patients who do not identify as White may be attributed to biases in health care delivery [69] .…”

Section: Operative Managementmentioning

confidence: 99%

Disparities in therapies for coronary artery disease with reduced left ventricular ejection fraction

Ghunaim,

Vervoort,

Elfaki

et al. 2023

Vessel Plus

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Revascularization through percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is used to manage left ventricular systolic dysfunction (LVSD) due to coronary artery disease (CAD). This review provides an overview of coronary revascularization for CAD with reduced left ventricular ejection fraction (LVEF), focusing on disparities in management. CABG provides more complete revascularization, and lower long-term all-cause mortality and reintervention and MI rates compared to PCI in patients with LVSD and CAD. Consequently, CABG is recommended as the primary revascularization therapy for CAD with reduced LVEF, with PCI being reserved for patients who are high-risk or have unfavorable coronary anatomy. Although LVSD increases revascularization risk, differential outcomes can be attributed to patients’ biological, behavioral, and socioeconomic factors as well as health system deficiencies. Women and racially and/or ethnically minoritized patients often present with progressive disease and greater comorbidity, experience delays in diagnosis and treatment, and have higher morbidity and mortality rates post-revascularization. These disparities may be explained by biological differences compounded by social determinants of health. Patients with CAD with LVSD pose unique medical challenges, which may be further complicated by disparities in care. Increased representation of minoritized patients in cardiovascular trials is needed to elucidate these differences and their long-term impact.

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Racial and ethnic differences in implantable cardioverter-defibrillator patient selection, management, and outcomes

Cited by 10 publications

References 74 publications

Racial and Ethnic Disparities in the Utilization and Outcomes with WATCHMAN FLX: A SURPASS analysis of the NCDR LAAO Registry

Racial and Ethnic Disparities in the Utilization and Outcomes with WATCHMAN FLX: A SURPASS analysis of the NCDR LAAO Registry

Arrhythmias and Ion Channelopathies Causing Sudden Cardiac Death in Hispanic/Latino and Indigenous Populations

Disparities in therapies for coronary artery disease with reduced left ventricular ejection fraction

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