Oct 4 2007
Researchers at Duke University Medical Center (DCRI) in the United States say there is disparity in the treatment men and women receive for heart failure in hospitals.
The researchers say men get a better deal than women and are far more likely to receive the therapy they need and the same applies to minority groups.
The study was part of the American Heart Association’s 'Get With The Guidelines', Heart Failure quality improvement program.
The researchers examined the use of implantable cardioverter defibrillators (ICD) over a two-year period among 13,034 patients hospitalized with heart failure in 217 hospitals.
They found that among those eligible for ICD therapy, only 35 percent actually had one of the devices in place or had plans for the therapy when they left the hospital.
An ICD is a three-inch pacemaker-like device that constantly monitors heart rhythms and uses electrical shocks to help control erratic rhythms that could cause the heart to stop beating.
Sudden cardiac death arises when electrical problems keep the heart from pumping properly and is responsible for half of all heart disease-related deaths;common risk factors include blocked heart arteries, a prior heart attack and a low ejection fraction.
Dr. Adrian Hernandez, the lead author of the study and a cardiologist at DCRI in Durham, North Carolina, says they found that white men are the most likely to get ICD therapy, black men are 25 percent less like to receive an ICD than white men, and women whether black or white, are 50 percent less likely to receive an ICD than white men.
Dr. Hernandez says cardiovascular disease is the leading cause of death for women, and survival among women with heart failure has not improved substantially over the past 10 to 20 years.
Hernandez says increasing use of ICDs among eligible women with heart failure is one way outcomes could be improved.
The researchers say it is unclear why there is a differences in ICD use but suggest that when new technology is first introduced, white men are usually the first to benefit.
They believe patient preference may be a factor or doctors may possibly approach women and black patients with different assumptions regarding their health care needs or desires.
According to guidelines ICD use is recommended for patients with heart failure who also have an ejection fraction of 30 percent or less which is a measure of the heart’s ability to pump.
Dr. Eric Peterson, the senior author of the paper and a member of the Get With The Guidelines – Heart Failure steering committee says there are no studies suggesting that sex or race should be considered in prescribing ICDs.
Dr. Peterson, a cardiologist and member of the DCRI, says the degree to which this technology is life-saving and not optional makes the findings all the more frightening.
Peterson says the data on ICD use comes from hospitals voluntarily taking part in a quality improvement initiative, therefore the study’s figures may underestimate the magnitude of the problem and ICD use might be substantially lower in centers that are not participating in the program.
Hernandez and Peterson say the Get With the Guidelines - Heart Failure program provides valuable feedback about the performances of doctors and hospitals and may help close the gap between evidence and practice.
However the researchers do cast doubt on how quickly full compliance will come as ICDs are costly ranging from $30,000 to $40,000 thousand dollars each.
They say debate over health care reform and the rationing of resources, and questions about who should get such devices, will continue despite current practice guidelines.
They also say there is no debate about the benefits of ICDs, and many may feel that any costs are justifiable if lives are saved.
The study was supported by the American Heart Association, with funding from GlaxoSmithKline.
Hernandez and Peterson and several of the co-authors are supported through grants from pharmaceutical companies and medical device makers that produce products for heart failure care.
The study appears in the October 3rd issue of the Journal of the American Medical Association.
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