Do Physicians’ Attitudes toward Implantable Cardioverter Defibrillator Therapy Vary by Patient Age, Gender, or Race?

Authors

  • Sana M. Al-Khatib M.D., M.H.S.,

    1. Duke Cardiovascular Center for Education and Research on Therapeutics, Duke Clinical Research Institute, Durham, NC
    2. Division of Cardiology, Duke University Medical Center, Durham, NC
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  • Gillian D. Sanders Ph.D.,

    1. Duke Cardiovascular Center for Education and Research on Therapeutics, Duke Clinical Research Institute, Durham, NC
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  • Sean M. O’Brien Ph.D.,

    1. Duke Cardiovascular Center for Education and Research on Therapeutics, Duke Clinical Research Institute, Durham, NC
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  • Daniel Matlock M.D., M.P.H.,

    1. Division of Internal Medicine, University of Colorado, Aurora, CO
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  • Louise O. Zimmer M.A., M.P.H.,

    1. Duke Cardiovascular Center for Education and Research on Therapeutics, Duke Clinical Research Institute, Durham, NC
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  • Frederick A. Masoudi M.D., M.S.P.H.,

    1. Division of Cardiology, Denver Health Medical Center, Denver, CO
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  • Eric Peterson M.D., M.P.H.

    1. Duke Cardiovascular Center for Education and Research on Therapeutics, Duke Clinical Research Institute, Durham, NC
    2. Division of Cardiology, Duke University Medical Center, Durham, NC
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  • Funding: This work was supported by the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (cooperative agreement number 1U18HS016964). The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ. Additional funding was provided by the Division of General Internal Medicine at the University of Colorado.

  • Disclosures: Sana Al-Khatib receives research funding from the AHRQ and the National Heart, Lung and Blood Institute (NHLBI), Medtronic and Biotronik. She receives speaking fees from Medtronic. Gillian Sanders receives research funding from the AHRQ, the National Cancer Institute, the NHLBI, and Medtronic.

  • Sean O’Brien: None. Daniel Matlock: None. This project was conducted while Dr. Matlock was a Hartford Geriatrics Health Outcomes Scholar. Louise Zimmer: None. Fred Masoudi receives research support from the AHRQ, the NHLBI and has contracts with Axio Research, Oklahoma Foundation for Medical Quality and the ACC. Eric Peterson: None.

  • The results of this analysis were presented in abstract form at the American College of Cardiology 59th Annual Scientific Sessions on March 15, 2010 in Atlanta, GA.

Address for correspondence: Sana M. Al-Khatib, M.D., DCRI, PO Box 17969, Durham, NC 27715. Fax: 919-668-7058; E-mail: alkha001@mc.duke.edu

Abstract

Background: Implantable cardioverter defibrillator (ICD) therapy improves survival of patients with systolic heart failure. We assessed whether physicians’ recommendation for ICD therapy varies as a function of patient age, gender, race, and physician's specialty.

Methods: We surveyed a random sample (n = 9969) of U.S. physicians who are active members of the American College of Cardiology (ACC). We asked participants about their likelihood to recommend ICD therapy in 4 clinical scenarios that randomly varied patient age, gender, race, and ICD indication (guideline Class I, Class IIa, Class III, and Class I in a noncompliant patient).

Results: Responses were received from 1210 physicians (response rate 12%), of whom 1127 met the study inclusion criteria. Responders and nonresponders had similar demographics. In responding to hypothetical clinical scenarios, physicians were less likely to recommend an ICD to older patients (≥80 vs 50 years) (P < 0.01) but were unaffected by gender or race for all class indications. Compared with nonelectrophysiologists (EPs), EPs were significantly more likely to recommend an ICD for a Class I indication (92.4% vs 81.4%; P < 0.01), but they were not more likely to offer an ICD for a Class III indication (0.4% vs 0.6%; P = 0.95).

Conclusions: Based on survey responses, physicians were equally willing to offer an ICD to men and women and to whites and blacks, but were less likely to offer an ICD to an older patient even when indicated by practice guidelines. Electrophysiologists (EPs) more often adhered to practice guideline recommendations on ICD therapy compared with non-EPs.

Ann Noninvasive Electrocardiol 2011;16(1):77–84

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