Heart Disease

Minorities Less Likely to Get Heart Device

Some health-care providers are dropping the ball when it comes to treating women and minorities with severe heart failure, a recent study shows. Yet the findings didn’t rock the cardiology world.
The study showed women and black and Hispanic patients were less likely to be offered an implantable cardioverter defibrillator, or ICD, a potentially lifesaving device that shocks the heart when it detects a dangerously irregular heart rhythm.
Such disparities are unfortunately old news, experts say, and this latest study confirms the problem isn’t going away.
Something needs to be done, said Samir Saba, M.D., a cardiac electrophysiologist at the University of Pittsburgh Medical Center, who was not involved in the study.
“Very few insights exist into the root causes,” said Dr. Saba, who has treated patients with heart failure for nearly two decades. The causes could relate to the doctor or to the patient, he said. “Here we are in 2017 … and still we are speculating about what could be going on.”
The study, published last summer in the journal Circulation, is among the American Heart Association’s top 10 heart and stroke science advances of 2016. It included more than 21,000 hospitalized heart failure patients at 236 hospitals that follow the AHA’s Get With The Guidelines-Heart Failure, a program that helps hospitals improve cardiovascular care.
Health-care providers—most of them cardiologists—talked to about one in five women about the option of receiving a defibrillator, compared with one in four men. Minorities were even more likely to be left in the dark. Compared with whites, blacks were 31 percent less likely and Hispanics 38 percent less likely to receive ICD counseling. Black and Hispanic patients were also less likely than their white counterparts to get or be prescribed an ICD. Women, however, were just as likely as men to get the device.
An estimated 5.7 million American adults have heart failure. Nearly half of patients die within five years of diagnosis.
A decade ago, similar research showed the vast majority of eligible patients who received a defibrillator were white. A couple years later, another study found more patients overall were receiving ICDs but numbers were still lower among women and black patients compared with white men.
Experts say results from this latest study might be explained by various failings. Doctors, for example, may in fact talk to patients about getting an ICD, but if patients chose not to get it, the conversation may not have been documented in medical records. Or, doctors might have thought about recommending an ICD, but didn’t because the patient seemed to be doing well.
Other doctors may have been hesitant to recommend a costly treatment that isn’t always fully covered by insurance, said Mark Link, M.D., a cardiac electrophysiologist at UT Southwestern in Dallas, who wasn’t involved in the recent study.
Cardiologists need more awareness that this problem exists “because I think we would all say, ‘Well, that’s not me, that’s not the way I think,’” he said.
As for patients, the disparities may be rooted in cultural factors related to race and ethnicity or factors related to income and education. Dr. Link recommends patients learn about their condition and treatment options, and then ask their doctors questions.
Cardiologist Adrian F. Hernandez, M.D., one of the study’s researchers, said it’s up to hospitals and health-care systems to make a change.
“I think the main thing is that we do need to have systems in place where we identify all [heart failure] patients who are at risk [for sudden death] and more uniformly approach them about how they can reduce that risk,” said Dr. Hernandez, of Duke University Hospital.
Some hospitals are already doing that.
At the University of Pittsburgh Medical Center, a feature is included in its electronic records program that reminds doctors to talk to eligible heart failure patients about getting an ICD. Massachusetts General Hospital is considering something similar.
But experts agree the most important first step is for cardiologists to offer the device to more patients, considering only about one in five were counseled about the option in the recent study.
“If we were to solve the major problem of why 80 percent are not being talked to about it, that in of itself may solve the secondary problems of ethnic disparities and gender disparities,” Dr. Saba said.
From American Heart Association News

Minorities Get an Excess of Ineffective Care

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