Men more likely to receive implantable defibrillators

Men Are Likelier to Receive
Heart Devices, Studies Show
By JENNIFER CORBETT DOOREN
October 3, 2007

WASHINGTON -- Men are much more likely than women to receive an
implantable defibrillator to prevent sudden cardiac death, according
to two studies led by Duke University researchers.

One of the studies, however, suggests that more than 60% of heart-
failure patients who fit the criteria to receive the device don't
receive it, regardless of gender or racial differences. The studies
will be published today in the Journal of the American Medical
Association.

One of the studies looked at Medicare patients and was based on
Medicare claims records from 1991 to 2005. Most of the analysis was
based on the period from 1999 to 2005, which researchers said
coincided with an expansion in Medicare coverage for the devices.

Defibrillators are designed to deliver electrical shocks or pulses on
an as-needed basis to help a malfunctioning heart beat properly.
Defibrillators are designed to treat a heart that beats too fast,
while a similar device, a pacemaker, is designed to pace a heart that
beats too slowly.

The market for implantable defibrillators is dominated by three
companies: Medtronic Inc., St. Jude Medical Inc. and Boston Scientific
Corp. The companies have been fighting to recharge a U.S. market that
was damaged by device recalls in 2005 and to figure out why many
patients at risk for sudden cardiac death still don't get the devices.

Patients with certain heart problems -- such as heart rhythm disorders
or heart failure, in which a damaged heart muscle doesn't properly
pump blood -- can be eligible to receive the devices in order to
prevent death. Patients who have already had a problem, such as a
heart attack, might also be eligible for the devices in order to
prevent a recurrence.

The Medicare study, which involved more than 200,000 patients, looked
at various subgroups of patients, but found that, overall, men
received the defibrillators at rates of two to three times as high as
women. The study was funded by a unit of the National Institutes of
Health.

One of the study authors, Adrian Hernandez, who is also a cardiologist
at Duke, based in Durham, N.C., said part of the difference could be
that some of the women had a type of heart failure that isn't
typically treated with a defibrillator and is more common in women
than men.

Dr. Hernandez explained that the Medicare claims database didn't
detail the type of heart failure among patients. Still, he says, any
difference in the type of heart failure isn't enough to account for
the entire gap between men and women.

Because of the limitations of looking only at Medicare claims data,
Dr. Hernandez and other researchers looked at a group of patients in
the second study who are part of an American Heart Association
campaign to have hospitals follow proper guidelines for treating heart-
failure patients. The campaign is funded in part by GlaxoSmithKline
PLC, researchers said, and the study itself was funded by an American
Heart Association pharmaceutical roundtable grant.

That study looked at 13,034 patients admitted to 217 hospitals in
January 2005 to June 2007. All of the patients had heart failure and
left ventricular ejection fraction of 30% or less, which is a measure
of how well the heart pumps blood. Such patients are eligible to
receive a defibrillator in most cases.

The study showed that 4,615 patients, or 35.4% of eligible patients,
had the defibrillators at hospital discharge or had plans to have one
implanted. The study also showed that women were about 40% less likely
to receive a defibrillator than men and that black patients were 30%
less likely to receive the device than white patients.

http://jama.ama-assn.org/cgi/content/full/298/13/1517

http://jama.ama-assn.org/cgi/content/short/298/13/1525

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