TY - JOUR
T1 - Management of ventricular arrhythmias in diverse populations in California
AU - Alexander, Mark
AU - Baker, Laurence
AU - Clark, Cheryl
AU - McDonald, Kathryn M.
AU - Rowell, Richard
AU - Saynina, Olga
AU - Hlatky, Mark A.
N1 - Funding Information:
Supported in part by grants HS07373 and HS08362 from the Agency for Healthcare Research and Quality, Rockville, Md, and by grant AG15272 from the National Institute on Aging, Bethesda, Md.
PY - 2002/9
Y1 - 2002/9
N2 - 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.
AB - 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.
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U2 - 10.1067/mhj.2002.125500
DO - 10.1067/mhj.2002.125500
M3 - Article
C2 - 12228779
AN - SCOPUS:0036733446
SN - 0002-8703
VL - 144
SP - 431
EP - 439
JO - American heart journal
JF - American heart journal
IS - 3
ER -