Socioeconomic and ethnic disparities in the use of biventricular pacemakers in heart failure patients with left ventricular systolic dysfunction.
Academic Article
Overview
abstract
OBJECTIVES: Biventricular pacing (BiV) is an important therapy for symptomatic heart failure (HF) patients with reduced left ventricular (LV) ejection fraction (EF). The aim of our study was to determine if ethnic disparities in use of BiV in HF patients with LV systolic dysfunction are independent of socioeconomic status. DESIGN, SETTING, PARTICIPANTS: Data collected on 32,911 hospitalized HF patients with EF < or = 35% from Pennsylvania hospitals that implanted BiVs in 2004 and 2005 were submitted to the Pennsylvania Health Care Cost Containment Council. Multivariate analysis used patient clinical, insurance and hospital characteristics to identify independent predictors of BiV in symptomatic HF patitents with EF < or = 35%. MAIN OUTCOME MEASURES: Use of BiV in symptomatic HF patients with LV systolic dysfunction. RESULTS: BiV was implanted in 2,065/ 15,861 (13%) Whites, 182/3107 (5.9%) African Americans and 175/1301 (13.5%) others. Older age, male sex, intraventricular conduction delay and prior myocardial infarction or bypass surgery (all P < .001) were positively associated with BiV while diabetes (P < .01), higher EF or higher Mediqual Atlas severity score (both P < .0001) were negatively associated with BiV. Adjusting for these variables, African American ethnicity (odds ratio [OR] .56, 95% CI,.46-68, P < .0001) and poverty, comparing the poorest quintile to other quintiles (OR .86, 95% CI, .76-98, P < .02), were associated with less BiV, independent of fixed effects of hospitals (P < .0001) and a positive association of BiV with Medicare vs Medicaid (P < .01). CONCLUSIONS: In a large statewide sample, BiV was implanted less frequently in African Americans and in lower-income patients, independent of clinical, hospital and insurance characteristics, identifying persisting disparities in use of advanced cardiac technology.
