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Disparity in use of implantable devices to prevent sudden death in heart failure patients
Date:12/18/2009

tight evidence or clear consensus in the field that they should be done.

Study design

The study, known as IMPROVE-HF (Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting), captured data from about six percent of the 40,000 cardiologists practicing in the U.S. For two years, beginning in 2005, researchers reviewed the medical records of 15,381 patients in 167 community-based and academic-affiliated outpatient cardiology practices geographically dispersed throughout the U.S. A representative sample of records was screened from each practice to yield an average of 90 patients per practice.

The data, which included patient demographics, medical history, heart function, laboratory results and treatments, was reviewed by a group of 34 chart review specialists. The investigators also evaluated the reasons that patients did not have ICD implantation, such as patient refusal and medical, economic or religious reasons.

Study findings

According to current guidelines, 7,532 patients in the study were eligible for ICD implantation; 311 of those had documented medical contraindications or other reasons for not receiving an ICD. Among the remaining 7,221 eligible patients, 3,659 (50.7 percent) had devices implanted.

Patients not offered the device despite the guidelines were most often older patients, blacks and those who did not have insurance. By contrast, men were more likely to receive a device than women. People whose hearts did not get enough blood and oxygen and those who had two types of heart rhythm disorders, atrial fibrillation and wide QRS, also were more likely to receive ICD therapy. The therapy also was more likely in patients treated with a variety of common heart disease medications, such as beta-blockers, statins and angiotensin-converting enzyme inhibitors.

Cardiology practices in the Northeast U.S. were more likely to adhere to guidelines, as were t
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Contact: BILL SEILER
bseiler@umm.edu
410-328-8919
University of Maryland Medical Center
Source:Eurekalert

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