Elderly male heart patients are two to three times more likely than females to receive implanted devices that shock a malfunctioning heart back into normal rhythms, and white men are about a third more likely than black men to receive them, researchers were reporting today.
Overall, only about a third of patients who are eligible for the potentially lifesaving implanted cardioverter-defibrillators are actually getting them, according to two studies in the Journal of the American Medical Association.
The devices, known as ICDs, “save lives, so the sex difference in treatment rates is worrisome,” said Lesley Curtis, a health economist at the Duke University Medical Center and lead author of one of the studies.
“We don’t know why the difference exists, but we do know that this is bad news for women,” added co-author Dr. Kevin Schulman of Duke, an internist and health policy expert.
As many as 450,000 Americans die each year when the electrical signals that initiate heartbeats become erratic, interfering with the organ’s ability to pump blood through the body. ICDs monitor the electrical impulses and, when they become irregular, shock the heart back into normal rhythms.
Clinical trials have shown that the devices, which are about the size of a cigarette pack and cost $30,000 to $40,000 to implant, can prolong life in 31 percent to 50 percent of patients who receive them.
Previous research has shown the gender disparity but suggested that the gap was closing. Today’s study, however, indicates it is getting wider.
In one study, Curtis and her colleagues studied a 5 percent sample of Medicare patients whose average age was 75.
One group of 136,421 patients had been diagnosed with a heart attack along with heart failure or cardiomyopathy, either of which left them susceptible to arrhythmia. A second group of 99,663 patients had suffered either a cardiac arrest or cardiac arrhythmia.
In the first group, 32.3 out of every 1,000 men had received an ICD, compared with only 8.6 out of every 1,000 women.
Yet the risk of death in the first year after enrollment in the study was the same in the group who received ICDs as in the group who did not, perhaps because of their advanced age.
The outcomes were better for the group that already had suffered an arrhythmia: The risk of death in the following year was 35 percent lower among those who received ICDs. Still, men were more likely to get the device: They were implanted in 102.2 out of every 1,000 men compared with 38.4 out of every 1,000 women.
In the second study, Dr. Adrian Hernandez and a slightly different team at Duke studied 13,034 patients with heart failure at 217 hospitals participating in a voluntary American Heart Association project.
They found that black men were 73 percent as likely to receive an ICD as white men, white women were 62 percent as likely, and black women were 56 percent as likely. Overall, only 35 percent of eligible patients received the devices.
Hernandez, a cardiologist, said the situation might be even worse in other hospitals that are not part of the American Heart Association project.
The studies were funded by the National Institutes of Health. All the physicians reported receiving lecture fees or grants from companies that manufacture the devices.
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