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 Medical Center 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. 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 healthcare 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 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 remind 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,” Saba said.
