Impact of an Automated Best Practice Alert on Sex and Race Disparities in Implantable Cardioverter-Defibrillator Therapy.
Alvin ThalappillilAmber E JohnsonAndrew D AlthouseFloyd ThomaJae LeeNathan A EstesSandeep JainJoon S LeeSamir F SabaPublished in: Journal of the American Heart Association (2022)
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.
Keyphrases
- end stage renal disease
- primary care
- ejection fraction
- newly diagnosed
- healthcare
- chronic kidney disease
- prognostic factors
- peritoneal dialysis
- left ventricular
- heart failure
- coronary artery disease
- acute myocardial infarction
- stem cells
- bone marrow
- skeletal muscle
- double blind
- insulin resistance
- social media
- patient reported
- smoking cessation
- drug induced
- health information
- percutaneous coronary intervention
- middle aged
- cardiac resynchronization therapy
- congenital heart disease
- general practice