July 7, 2023Open Access
Disparities in Referral and Utilization of Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death
Structured PICO
Does male sex increase the referral and utilization of primary prevention ICDs in patients with reduced LVEF eligible for primary prevention?
P
Population
4,406 patients with reduced LVEF eligible for primary prevention implantable cardioverter-defibrillators (ICDs) admitted to hospitals from 2010 to 2020 in Nova Scotia, Canada (71% men, 29% women).
I
Intervention
Male sex
C
Comparator
Female sex
O
Outcome
Referral and utilization (implantation) rates of primary prevention ICDs
There is a significant sex disparity in the utilization of primary prevention ICDs, with eligible men being more than twice as likely to receive an ICD compared to eligible women.
Abstract
BACKGROUND: Implantable cardioverter-defibrillators (ICDs) reduce mortality in patients with reduced left ventricular ejection fraction (LVEF). We investigated sex disparities in a contemporary Canadian population for utilization of primary prevention ICDs. METHODS: This was a retrospective cohort study on patients with reduced LVEF admitted to hospitals from 2010 to 2020 in Nova Scotia (population = 971,935). RESULTS: There were 4406 patients eligible for ICDs: 3108 (71%) men and 1298 (29%) women. The mean follow-up time was 3.9 ± 3.0 years. Rates of coronary disease were similar between men and women (45.8% vs 44.0%; P = 0.28), but men had lower LVEF (26.6 ± 5.9% vs 27.2 ± 5.8%; P = 0.0017). The referral rate for ICD was 11% (n = 487), with 13% of men (n = 403) and 6.5% of women (n = 84) referred (P < 0.001). The ICD implantation rate in the population was 8% (n = 358), with 9.5% of men (n = 296) and 4.8% of women (n = 62) (P < 0.001) receiving the device. Men were more likely than women to receive an ICD (odds ratio 2.08, 95% confidence interval 1.61-2.70; P < 0.0001)). There was no significant difference in mortality between men and women (P = 0.2764). There was no significant difference in device therapies between men and women (43.8% vs 31.1%; P = 0.0685). CONCLUSIONS: A significant disparity exists in the utilization of primary prevention ICDs between men and women in a contemporary Canadian population.