Acute Care/Hospitalization

Physician recommendations for defibrillator therapy not influenced by race or gender

Implantable cardioverter defibrillator (ICD) therapy improves survival of patients with systolic heart failure (HF). Yet, one database showed that only 35 percent of all patients having a Class I indication (clearly recommended) for an ICD either had an ICD or were scheduled for ICD implantation. Despite earlier reports about racial and gender disparities in the use of ICD therapy, the vast majority of physicians would recommend an ICD to patients with a Class I indication for the device without regard to the gender or race of the patient, according to a new survey. However, physicians were less likely to recommend an ICD to patients 80 years or older than they were to patients 50 to 80 years old.

The significance of this finding is uncertain due to the paucity of data on the efficacy and safety of ICD therapy in older patients. Also, electrophysiologists were significantly more likely to recommend an ICD for a Class I indication (92.4 vs. 81.4 percent) than nonelectrophysiologists. They were not more likely to recommend an ICD for Class III (clearly not recommended) indications (0.4 vs. 0.6 percent).

The survey polled 9,969 U.S. physicians actively enrolled in the American College of Cardiology, of whom 1,210 (12 percent) responded. The survey presented four clinical scenarios asking respondents for their recommendations regarding ICD use. The scenarios differed by level of recommendation for ICD use: clearly recommended by current guidelines, clearly not recommended by current guidelines, reasonable but not clearly indicated, and recommended by current guidelines but with a patient who was previously noncompliant with recommended medical therapy. "Patients" differed by age, gender, and race.

The researchers believe that racial and gender disparities observed in earlier studies may not have been motivated by physician bias. This study was supported by the Agency for Healthcare Research and Quality (HS16964).

See "Do physicians' attitudes toward implantable cardioverter defibrillator therapy vary by patient age, gender, or race?" by Sana M. Al-Khatib, M.D., Gillian D. Sanders, Ph.D., Sean M. O'Brien, and others in the Annals of Noninvasive Electrocardiology 16(10), pp. 77-84, 2011.

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