Management of ventricular arrhythmias in diverse populations in California

Mark Alexander, Laurence Baker, Cheryl Clark, Kathryn M. McDonald, Richard Rowell, Olga Saynina, Mark A. Hlatky

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Abstract

Background. The use of coronary angiography and revascularization is lower than expected among black patients. It is uncertain whether use of other cardiac procedures also varies according to race and ethnicity and whether outcomes are affected. Methods. We analyzed discharge abstracts from all nonfederal hospitals in California of patients hospitalized for a primary diagnosis of ventricular tachycardia or ventricular fibrillation between 1992 and 1994. We compared mortality rates and use of electrophysiologic study (EPS) and implantable cardioverter-defibrillator (ICD) procedures according to the race and ethnicity of the patient. Results. Among 8713 patients admitted with ventricular tachycardia or ventricular fibrillation, 29% (n = 2508) had a subsequent EPS procedure, and 9% (n = 818) had an ICD implanted. After controlling for potential confounding factors, we found that black patients were significantly less likely than white patients to undergo EPS (odds ratio 0.72, Cl 0.56-0.92) or ICD implantation (odds ratio 0.39, Cl 0.25-0.60). Blacks discharged alive from the initial hospital admission had higher mortality rates over the next year than white patients, even after controlling for multiple confounding risk factors (risk ratio 1.18, Cl 1.03-1.36). The use of EPS and ICD procedures was also significantly affected by several other factors, most notably by on-site procedure availability but also by age, sex, and insurance status. Conclusions. In a large population of patients hospitalized for ventricular arrhythmia, blacks had significantly lower rates of utilization for EPS and ICD procedures and higher subsequent mortality rates.

Original languageEnglish (US)
Pages (from-to)431-439
Number of pages9
JournalAmerican heart journal
Volume144
Issue number3
DOIs
StatePublished - Sep 2002
Externally publishedYes

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Alexander, M., Baker, L., Clark, C., McDonald, K. M., Rowell, R., Saynina, O., & Hlatky, M. A. (2002). Management of ventricular arrhythmias in diverse populations in California. American heart journal, 144(3), 431-439. https://doi.org/10.1067/mhj.2002.125500