Impact of an Automated Best Practice Alert on Sex and Race Disparities in Implantable Cardioverter-Defibrillator Therapy.

Abstract

Background Implantable cardioverter-defibrillators (ICDs) are indicated in patients with severe left ventricular dysfunction, but many eligible patients do not receive them, especially women and Black patients. Our group had previously demonstrated that a best practice alert (BPA) improves overall rates of electrophysiology referrals and ICD implantations. This study examined the impact of a BPA by sex and race. Methods and Results This is a cluster randomized trial of cardiology (n=106) and primary care (n=89) providers who were randomized to receive (BPA, n=93) or not receive (No BPA, n=102) the alert and managed 1856 patients meeting primary prevention criteria for ICD implantation (965 BPA and 891 No BPA). After a median follow up of 34 months, 630 (34%) patients were referred to electrophysiology, and 522 (28%) patients received an ICD. Compared with the No BPA arm, patients in the BPA arm saw a modest differential increase in the rate of electrophysiology referrals at 18 months in men (+4%) compared with women (+7%) but a profound increase in Black patients (+16%) compared with White patients (+2%), thus closing the sex and race gaps. Similar trends were noted for rates of ICD implantation. Conclusions Use of a BPA improves rates of electrophysiology referrals and ICD implantations in all comers with severe cardiomyopathy and no prior ventricular arrhythmias but has a more pronounced impact in women and Black patients. The use of a BPA at the point of care is an effective tool in the fight against sex and race inequities in health care.

• Authors: Alvin Thalappillil, Amber Johnson, Andrew Althouse, Floyd Thoma, Jae Lee, N A Mark Estes 3rd, Sandeep Jain, Joon Lee, Samir Saba
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 11 Issue 7 Pg. e023669 (04 05 2022) ISSN: 2047-9980 [Electronic] England
• PMID: 35301858 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Arrhythmias, Cardiac (etiology)
• Cardiology
• Cardiomyopathies (etiology)
• Death, Sudden, Cardiac (epidemiology, etiology, prevention & control)
• Defibrillators, Implantable (adverse effects)
• Female
• Humans
• Male
• Ventricular Dysfunction, Left (etiology)