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Racial and Ethnic Disparities in Implantable Cardioverter-Defibrillator Utilization: A Contemporary Review

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Abstract

Purpose of review

Sudden cardiac arrest is associated with high morbidity and mortality. Despite having a disproportionate burden of sudden cardiac death (SCD), rates of primary and secondary prevention of SCD with implantable cardioverter-defibrillator (ICD) therapy are lower among eligible racially minoritized patients. This review highlights the racial and ethnic disparities in ICD utilization, associated barriers to ICD care, and proposed interventions to improve equitable ICD uptake.

Recent findings

Racially minoritized populations are disproportionately eligible for ICD therapy but are less likely to see cardiac specialists, be counseled on ICD therapy, and ultimately undergo ICD implantation, fueling disparate outcomes. Racial disparities in ICD utilization are multifactorial, with contributions at the patient, provider, health system, and structural/societal level.

Summary

Racial and ethnic disparities have been demonstrated in preventing SCD with ICD use. Proposed strategies to mitigate these disparities must prioritize care delivery and access to care for racially minoritized patients, increase the diversification of clinical and implementation trial participants and the healthcare workforce, and center reparative justice frameworks to rectify a long history of racial injustice.

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Funding

Larry R. Jackson II reports grants from the National Heart, Lung, and Blood Institute (NIH- 1 K01 HL159041-01) and the American Heart Association (AHA- 851386). Lauren Eberly receives funding from American Heart Association (23CDA1050650) and the Winn Diversity in Clinical Trial Career Development Award.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Tarryn Tertulien MD, MSc

  2. Division of Cardiology, San Antonio Military Medical Center, Fort Sam Houston, TX, USA

    Kelvin Bush MD

  3. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA

    Larry R. Jackson II MD, MHS

  4. Division of General Internal Medicine – Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

    Utibe R. Essien MD, MPH

  5. Cardiovascular Division, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Lauren Eberly MD, MPH

Authors
  1. Tarryn Tertulien MD, MSc
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  2. Kelvin Bush MD
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  3. Larry R. Jackson II MD, MHS
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  4. Utibe R. Essien MD, MPH
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  5. Lauren Eberly MD, MPH
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Corresponding author

Correspondence to Lauren Eberly MD, MPH.

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Conflict of Interest

Larry R. Jackson II reports consulting fees from Sanofi, Johnson and Johnson, Inc., Pfizer, Bristol-Myers Squibb, and Biosense Webster, Inc. Dr. Jackson also reports payment or honoraria from Zoll Life Vest, CME Outfitters, Prime Education, Health Monitor, and WebMD/Medscape. Lauren Eberly reports speaking fees from Pfizer, and Virtual Advisory Board: Understanding Native American/Alaskan Native Population and Cardiac Amyloidosis (Pfizer). The other authors have nothing to disclose.

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Tertulien, T., Bush, K., Jackson, L.R. et al. Racial and Ethnic Disparities in Implantable Cardioverter-Defibrillator Utilization: A Contemporary Review. Curr Treat Options Cardio Med 25, 771–791 (2023). https://doi.org/10.1007/s11936-023-01025-z

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