Abstract 364: Evaluating the Impact of Economic Disparities on the Distribution of Wearable Cardioverter-defibrillator in Patients Post Myocardial Infarction With a Reduced Ejection Fraction

Abstract

Background: Current guidelines recommend wearable cardioverter-defibrillator (WCD) for primary prevention of sudden cardiac death (SCD) in patients with ischemic cardiomyopathy and ejection fraction (EF) less than 35% if they are within 40 days of an ischemic event or within 90 days if revascularized. We sought to assess what impact economic factors have on determining which patients receive a WCD and their post-discharge outcomes. Methods: This is a single-center, retrospective cohort study investigating outcomes in patients admitted for myocardial infarction at a large, academic, tertiary referral center, who qualified for WCD over an 18-month period. Patients were stratified based on if a WCD was received or not upon discharge. Demographic, clinical, and diagnostic cardiovascular information, including EF, were obtained. Low income patients were identified as living in an area where median household income is less than $30000 annually. Results: Fifty-four patients were included in this study and mean age of all patients was 62.5 (± 10.19) years old. The mean EF was comparable between those discharged with versus without a WCD (24.88 ± 7.13 and 24.5 ± 7.5, respectively; p=0.860). Patients who were discharged without a WCD were more likely to be self-pay or receiving Medicaid (3.6% vs 38.5%; 17.9% vs 23.1%), and more likely to come from a low-income area (47.36% vs 55.55%). During a follow up period of 40 and 90 days, the mortality in those without WCD trended to be higher, approaching statistical significance (p = 0.09). Two patients from each cohort received an ICD following the defined period. Conclusion: The current WCD guidelines were based on observational studies. The results from the first randomized control trial investigating WCD use (VEST trial) have led to questions regarding its actual benefit. However, important limitations to VEST include low WCD usage, and non-compliance to wearing the WCD. Here we have demonstrated that WCD use in patients with immediate post-infarct cardiomyopathy with reduced EF trended towards improved mortality. Economic factors negatively impact who receives this life-saving device. Future directions from our study include stratifying patients based on severity of disease (e.g. severely reduced EF (<25%), evidence of new onset reduced EF and prioritizing patients likely to be more compliant). More studies are needed to further investigate economic disparities associated with use of the WCD.