Racial Differences in Outcome in the Multicenter UnSustained Tachycardia Trial (MUSTT)

Russo, Andrea M.; Hafley, Gail E.; Lee, Kerry L.; Stamato, Nicholas J.; Lehmann, Michael H.; Page, Richard L.; Kús, Teresa; Buxton, Alfred E.

doi:10.1161/01.cir.0000078640.59296.6f

Cited by 29 publications

(10 citation statements)

References 21 publications

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“…The Multicenter UnSustained Tachycardia Trial (MUSTT) had underrepresentation of non-white patients with only 14% minority patients enrolled in the trial; 21 however, the Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) trial had a higher percentage of non-white patients with 33% minority patients. 22 Neither of these trials published secondary analyses of the outcomes of minority patients.…”

Section: Discussionmentioning

confidence: 99%

Primary Prevention Implantable Cardioverter-Defibrillators in Older Racial and Ethnic Minority Patients

Pokorney

Hellkamp

Yancy

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background Racial and ethnic minorities are underrepresented in clinical trials of primary prevention implantable cardioverter-defibrillators (ICDs). This analysis investigates the association between primary prevention ICDs and mortality among Medicare, racial/ethnic minority patients. Methods and Results Data from Get With The Guidelines-Heart Failure Registry and National Cardiovascular Data Registry's-ICD Registry were used to perform an adjusted comparative effectiveness analysis of primary prevention ICDs in Medicare, racial/ethnic minority patients (non-white race or Hispanic ethnicity). Mortality data were obtained from the Medicare denominator file. The relationship of ICD to survival was compared between minority and white non-Hispanic patients. Our analysis included 852 minority patients, 426 ICD and 426 matched non-ICD patients, and 2,070 white non-Hispanic patients (1,035 ICD and 1,035 matched non-ICD patients). Median follow-up was 3.1 years. Median age was 73 years, and median ejection fraction was 23%. Adjusted 3-year mortality rates for minority ICD and non-ICD patients were 44.9% (95% CI: 44.2-45.7%) and 54.3% (95% CI: 53.4-55.1%), respectively (adjusted HR 0.79, CI: 0.63-0.98, p=0.034). White non-Hispanic patients receiving an ICD had lower adjusted 3-year mortality rates of 47.8% (95% CI: 47.3-48.3%) compared with 57.3% (95% CI: 56.8-57.9%) for those with no ICD (adjusted HR 0.75, 95% CI 0.67-0.83, p<0.0001). There was no significant interaction between race/ethnicity and lower mortality risk with ICD (p=0.70). Conclusions Primary prevention ICDs are associated with lower mortality in non-white and Hispanic patients, similar to that seen in white, non-Hispanic patients. These data support a similar approach to ICD patient selection, regardless of race or ethnicity.

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Section: Discussionmentioning

confidence: 99%

Primary Prevention Implantable Cardioverter-Defibrillators in Older Racial and Ethnic Minority Patients

Pokorney

Hellkamp

Yancy

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…In this subgroup analysis, CRT and race did not contribute a statistically significant interaction to primary outcome, although the primary endpoint within the race subset was not statistically significant secondary to small sample sizes (Central Illustration). An analysis of the racial subgroups in the MUSTT (Multicenter Unsustained Tachycardia Trial) found that black patients did not do as well when randomized to electrophysiologic-guided therapy for ICD placement, although the number of black patients in the subgroup analysis was small (n = 61) (20) (Central Illustration). Similarly, a subgroup analysis of black patients in the MADIT-II trial was not found to have a mortality benefit, but was limited by small patient numbers (n = 102) (21) (Central Illustration).…”

Section: Discussionmentioning

confidence: 99%

Clinical Effectiveness of CRT and ICD Therapy in Heart Failure Patients by Racial/Ethnic Classification

Ziaeian

Zhang

Albert

et al. 2014

Journal of the American College of Cardiology

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BACKGROUND Clinical trials have demonstrated benefit for cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) therapies in patients with heart failure with reduced ejection fraction (HFrEF); yet, questions have been raised with regard to the benefit of device therapy for minorities. OBJECTIVES The purpose of this study was to determine the clinical effectiveness of CRT and ICD therapies as a function of race/ethnicity in outpatients with HFrEF (ejection fraction ≤35%). METHODS Data from IMPROVE HF (Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting) were analyzed by device status and race/ethnicity among guideline-eligible patients for mortality at 24 months. Multivariate Generalized Estimating Equations analyses were conducted, adjusting for patient and practice characteristics. RESULTS The ICD/cardiac resynchronization defibrillator (CRT-D)–eligible cohort (n = 7,748) included 3,391 (44%) non-Hispanic white, 719 (9%) non-Hispanic black, and 3,638 (47%) other racial/ethnic minorities or race-not-documented patients. The cardiac resynchronization pacemaker (CRT-P)/CRT-D–eligible cohort (n = 1,188) included 596 (50%) non-Hispanic white, 99 (8%) non-Hispanic black, and 493 (41%) other/not-documented patients. There was clinical benefit associated with ICD/CRT-D therapy (adjusted odds ratio: 0.64, 95% confidence interval: 0.52 to 0.79, p = 0.0002 for 24-month mortality), which was of similar proportion in white, black, and other minority/not-documented patients (device–race/ethnicity interaction p = 0.7861). For CRT-P/CRT-D therapy, there were also associated mortality benefits (adjusted odds ratio: 0.55, 95% confidence interval: 0.33 to 0.91, p = 0.0222), and the device–race/ethnicity interaction was not significant (p = 0.5413). CONCLUSIONS The use of guideline-directed CRT and ICD therapy was associated with reduced 24-month mortality without significant interaction by racial/ethnic group. Device therapies should be offered to eligible heart failure patients, without modification based on race/ethnicity.

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“…7–11 While several studies have highlighted utilization disparities among ICD eligible AA patients, 12–14 racial differences in outcomes have not been well examined in ICD recipients. 15–17 In the SCD-HeFT study (425 AA and 1932 Caucasian), mortality risk was significantly higher in AA compared with Caucasians, but there was no significant difference in the rate of ICD shocks. 16 In addition, the survival benefit from the ICD (i.e., reduction in the risk of mortality) compared to conventional therapy was similar in AA and Caucasian patients.…”

Section: Discussionmentioning

confidence: 99%

“…12–14 Hence, there is limited data on whether outcomes after implantation of primary prevention ICDs in AA differ from other racial/ethnic groups. 15–17 The main objective of this study was to compare the risk of ICD shock and mortality among AAs and non-AAs in the Prospective Observational Study of Implantable Cardioverter-Defibrillators (PROSE-ICD), a large well-phenotyped cohort of patients with ischemic and non-ischemic cardiomyopathy undergoing ICD implantation for primary prevention of SCD.…”

Section: Introductionmentioning

confidence: 99%

Outcomes in African Americans undergoing cardioverter-defibrillator implantation for primary prevention of sudden cardiac death: Findings from the Prospective Observational Study of Implantable Cardioverter-Defibrillators (PROSE-ICD)

et al. 2014

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Background Implantable cardioverter defibrillators (ICDs) reduce the risk of death in patients with left ventricular dysfunction. Little is known regarding the benefit of this therapy in African-Americans (AA). Objective To determine the association between African-American race and outcomes in a cohort of primary prevention cardioverter defibrillators (ICD) patients. Methods We conducted a prospective cohort study of patients with systolic heart failure who underwent ICD implantation for primary prevention of sudden cardiac death. The primary endpoint was appropriate ICD shock defined as a shock for rapid ventricular tachyarrhythmias. The secondary endpoint was all-cause mortality. Results There were 1,189 patients (447 AAs and 712 non-AAs) enrolled. Over a median follow-up of 5.1 years, a total of 137 patients experienced an appropriate ICD shock, and 343 died (294 of whom died without receiving an appropriate ICD shock). The multivariate adjusted hazard ratios (95% CI) comparing AAs vs. non-AAs were 1.24 (0.96 to 1.59) for all-cause mortality, 1.33 (1.02, 1.74) for all-cause mortality without receiving appropriate ICD shock, and 0.78 (0.51, 1.19) for appropriate ICD shock. Ejection fraction, diabetes, and hypertension appeared to explain 24.1% (10.1 to 69.5%), 18.7% (5.3 to 58.0%), and 13.6% (3.8 to 53.6%) of the excess risk of mortality in AAs, with a large proportion of the mortality difference remains unexplained. Conclusions In patients with primary prevention ICDs, AAs had an increased risk of dying without receiving an appropriate ICD shock compared to non-AAs.

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Racial Differences in Outcome in the Multicenter UnSustained Tachycardia Trial (MUSTT)

Cited by 29 publications

References 21 publications

Primary Prevention Implantable Cardioverter-Defibrillators in Older Racial and Ethnic Minority Patients

Primary Prevention Implantable Cardioverter-Defibrillators in Older Racial and Ethnic Minority Patients

Clinical Effectiveness of CRT and ICD Therapy in Heart Failure Patients by Racial/Ethnic Classification

Outcomes in African Americans undergoing cardioverter-defibrillator implantation for primary prevention of sudden cardiac death: Findings from the Prospective Observational Study of Implantable Cardioverter-Defibrillators (PROSE-ICD)

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