Abstract 3629: Socioeconomic and Ethnic Disparities in the Use of Biventricular Pacemakers in Heart Failure Patients with Left Ventricular Systolic Dysfunction

Abstract

Background : Biventricular pacing (BiV) is an important therapeutic advance for symptomatic heart failure (HF) patients (pts) with reduced left ventricular ejection fraction (EF), but whether socioeconomic and ethnic disparities exist in the use of BiV in HF pts is unknown. Methods : Data were collected on all hospitalized HF pts with an EF ≤ 35% from Pennsylvania hospitals that implanted BiVs from Jan. 2004 to Dec. 2005. These hospitals submitted clinical data from chart abstraction and administrative data to the Pennsylvania Health Care Cost Containment Council. Multiple logistic regression analyses used patient clinical data, insurance and hospital characteristics to identify independent predictors of BiV implantation in symptomatic HF pts with EF≤ 35%. Results : Of the 20,269 HF pts with EF≤ 35%, BiV was implanted in 2,065/15,861 (13%) whites, 182/3107 (5.9%) African-Americans and 175/1301 (13.5%) others. Analysis of 12 clinical variables identified associations of older age, male gender and prior myocardial infarction or bypass surgery with a higher likelihood of BiV implantation (all p<.0001). Pts with diabetes or higher Mediqual Atlas severity score were less likely to have BiV implantation (both p<.01). Pts with lower EF or with intraventricular conduction delay were more likely to have BiV implantation (both p<.0001). After adjusting for these variables, African-American ethnicity (odds ratio (OR) 0.50, [95% confidence interval (CI) 0.42– 0.60], p<.0001) and poverty level (defined as the percentage of residents in a zip code whose household income was below the federal poverty threshold) comparing the poorest quintile to the other quintiles (OR 0.79, [95% CI 0.70 – 0.89], p<.0001), were independently associated with lower likelihood of BiV implantation. Additional independent predictors of a higher likelihood of BiV implantation included commercial and Medicare vs. Medicaid, self-pay or other insurance type, and for-profit hospital status (both p<.05). Conclusion : In a large statewide sample, BiV was implanted less frequently in African-Americans and in lower income pts, independent of clinical, hospital and insurance characteristics, identifying persisting disparities in use of advanced cardiac technology.