Prior studies have demonstrated racial/ethnic differences in access to innovative cardiovascular

1. Racial and Ethnic Differences in Nationwide Utilization of Cardiac Resynchronization Therapy Steven A. Farmer, MD PhD, James N. Kirkpatrick, MD University of Pennsylvania, Philadelphia, PA · Paul A. Heidenreich, MD MS, Stanford University, Palo Alto, CA · Jeptha P. Curtis, MD, Yongfei Wang, MS Yale University, New Haven, CT · Peter W. Groeneveld, MD MS, University of Pennsylvania, Philadelphia, PA; on behalf of the National Cardiovascular Data Registry Background and Objectives • Prior studies have demonstrated racial/ethnic differences in access to innovative cardiovascular technologies. • Disparities in access to cardiac resynchronization therapy with defibrillator (CRT-D) may exist since this relatively new technology requires providers with substantial clinical expertise. Methods • Data from the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR) for implantable cardiovascular defibrillators (ICDs) from Jan 2005-April 2007. • Selected white, black, or Hispanic patients with no prior CRT or ICD device and meeting established clinical criteria for CRT-D. • Fit a multivariable hierarchical logistic regression model with receipt of either non-resynchronizing ICD or CRT-D as the outcome variable. • Independent variables included race/ethnicity, age, gender, cardiomyopathy etiology, duration of CHF, LVEF, blood pressure, QRS duration/morphology, prior revascularization, atrial fibrillation / flutter, cerebrovascular disease, hypertension, diabetes, renal failure, and pulmonary disease. Conclusions Study Participants • Among patients in the ACC-NCDR ICD registry who met established clinical criteria, black and Hispanic patients were less likely to receive CRT-D. • These differences persisted despite extensive multivariate adjustment for demographic and clinical covariates. • Differences in availability of EP providers with advanced training may have contributed to these findings. * Data are presented as number (percent) unless otherwise indicated. Abbreviations: CRT–D Cardiac resynchronization therapy-Defibrillator; CHF–Congestive heart failure; RBBB–Right bundle branch block; LBBB–Left bundle branch block; SBP – systolic blood pressure; ESRD -End Stage Renal Disease Results • Of 108,341 registry subjects, 31,434 met inclusion criteria, including 26,540 white (84%), 3,332 black (11%), and 1,562 Hispanic (5%) patients. • In unadjusted analyses, white patients (81%) received CRT-D more frequently than black (77%) or Hispanic (75%) patients (p<0.001). Implications • Even though they were eligible by established criteria, were seen by a subspecialist, and received an ICD, minority patients were still less likely to receive CRT-D. • Our findings indicate that more aggressive use of CRT-D amongst eligible minority patients may improve quality of care and decrease racial / ethnic disparities.