Patlolla Sri Harsha, Schaff Hartzell V, Nishimura Rick A, Geske Jeffrey B, Dunlay Shannon M, Ommen Steve R
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2022 Mar;97(3):507-518. doi: 10.1016/j.mayocp.2021.07.022. Epub 2021 Dec 7.
To evaluate if there are sex and race disparities in use of implantable cardioverter-defibrillator (ICD) devices for prevention of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM).
Using the National Inpatient Sample from January 2003 through December 2014, we identified all adult admissions with a diagnosis of HCM and an ICD implantation. Race was classified as White versus non-White. Trends in ICD use, predictors of ICD implantation, device-related complications, hospitalization costs, and lengths of stay were evaluated.
Among a total of 23,535 adult hospitalizations for HCM, ICD implantation was performed in 3954 (16.8%) admissions. Over the study period, there was an overall increasing trend in ICD use (11.6% in 2003 to 17.0% in 2014, P<.001). Compared with admissions not receiving an ICD, those receiving an ICD had shorter median lengths of in-hospital stay but higher hospitalization costs (P<.001). Compared with men and White race, female sex (odds ratio, 0.72; 95% CI, 0.66 to 0.78; P<.001) and non-White race (odds ratio, 0.87; 95% CI, 0.79 to 0.96; P<.001) were associated with lower adjusted odds of receiving an ICD. Women and non-White hospitalizations had higher rates of device related complications, longer lengths of in-hospital stay, and higher hospitalization costs compared with men and White race, respectively (all P<.01).
Among HCM hospitalizations, ICD devices are underused in women and racial minorities independent of demographics, hospital characteristics, and comorbidities. Women and racial minorities also had higher rates of complications and greater resource use compared with men and those belonging to the White race, respectively.
评估在肥厚型心肌病（HCM）患者中，使用植入式心脏复律除颤器（ICD）预防心源性猝死是否存在性别和种族差异。
利用2003年1月至2014年12月的全国住院患者样本，我们确定了所有诊断为HCM且植入ICD的成年住院患者。种族分为白人和非白人。评估了ICD的使用趋势、ICD植入的预测因素、与设备相关的并发症、住院费用和住院时间。
在总共23535例成年HCM住院患者中，3954例（16.8%）接受了ICD植入。在研究期间，ICD的使用总体呈上升趋势（2003年为11.6%，2014年为17.0%，P<0.001）。与未接受ICD的住院患者相比，接受ICD的患者住院中位时间较短，但住院费用较高（P<0.001）。与男性和白人相比，女性（比值比，0.72；95%可信区间，0.66至0.78；P<0.001）和非白人（比值比，0.87；95%可信区间，0.79至0.96；P<0.001）接受ICD的调整后比值较低。与男性和白人相比，女性和非白人住院患者的设备相关并发症发生率更高、住院时间更长、住院费用更高（均P<0.01）。
在HCM住院患者中，女性和少数族裔独立于人口统计学、医院特征和合并症，ICD的使用不足。与男性和白人相比，女性和少数族裔的并发症发生率也更高，资源利用也更多。
