Key result
Black CIED recipients face ~43% higher MACE risk vs. White patients, largely mediated by follow-up disparities.
Why the study?
Disparities in consensus-recommended follow-up for cardiac implantable electronic devices and their impact on long-term outcomes remain underexplored.
Do Black patients experience worse clinical outcomes following CIED implantation compared to White patients, and is this disparity mediated by adherence to consensus-recommended follow-up?
Cohort (n=6,806)
Do Black patients experience worse clinical outcomes following CIED implantation compared to White patients, and is this disparity mediated by adherence to consensus-recommended follow-up?
Hazard Ratio: 1.43 (95% CI 1.27–1.61)
p-value: p=<0.001
Racial disparities in clinical outcomes following CIED implantation are prevalent, but adherence to consensus-recommended follow-up is a modifiable factor that significantly mediates these disparities.
Racial disparities in device follow-up persist; hypothesis-generating for whether closing gaps reduces MACE risk, pending prospective trials.
Background Despite advances in cardiac implantable electronic device (CIED) management and widespread adoption of remote monitoring, disparities in consensus-recommended follow-up and their impact on long-term outcomes remain underexplored. Objective This study investigates racial disparities in CIED consensus-recommended follow-up and their association with clinical outcomes. Methods This was a retrospective longitudinal study of 6,806 patients (62.0% White and 38.0% Black) with CIEDs implanted (2019-2023) with a median follow-up of 3.5 years (IQR 2.2-5.0). CIED 1-year consensus-recommended follow-up was defined as ≥1 in-person + ≥1 remote visit for pacemakers, and ≥1 in-person + ≥2 remote visits for defibrillators. Outcomes included major adverse cardiovascular events (MACE: acute myocardial infarction, HF hospitalization, stroke, major bleeding [gastrointestinal and/or intracranial], or cardiac arrest), device extraction, and any revision/upgrade. Logistic and Cox models, adjusted for demographics and comorbidities, assessed consensus-recommended follow-up disparities and outcomes. Mediation analysis quantified the proportion of outcome disparities explained by consensus-recommended follow-up. Results Significant baseline differences were observed between Black and White patients in age, sex, income, and clinical comorbidities (p<0.001). Black patients had significantly lower consensus-recommended follow-up (OR 0.83; 95% CI: 0.73-0.94; p=0.002). Over time, Black patients experienced higher risk of MACE (HR 1.43; 95% CI: 1.27-1.61; p<0.001) and device extraction (HR 1.32; 95% CI: 1.09-1.61; p=0.005), with no difference in device upgrades (HR 0.85; 95% CI: 0.62-1.29; p=0.341). Consensus-recommended follow-up mediated 44.4% of the racial disparity in MACE and 28.4% in device extraction. Conclusion Racial disparities persist in CIED follow-up and outcomes. Follow-up adherence is a modifiable factor influencing outcomes and may guide strategies to improve equity in device-based care.
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Huang et al. (2026) conducted a cohort in Cardiac implantable electronic devices (CIEDs) (n=6,806). Black race vs. White race was evaluated on Major adverse cardiovascular events (MACE) (HR 1.43, 95% CI 1.27-1.61, p=<0.001). Black patients with CIEDs had a higher risk of MACE compared to White patients (HR 1.43; 95% CI 1.27-1.61; P<0.001), with lower follow-up adherence mediating 44.4% of this racial disparity.
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