Heart devices go to older men

At issue is women with heart disease are often not being identified.

LOS ANGELES TIMES

Elderly male heart patients are two to three times more likely than females to receive implanted devices that shock a malfunctioning heart back into normal rhythms, and white men are about a third more likely than black men to receive them, researchers reported today.

Overall, only about a third of patients who are eligible for the potentially lifesaving implanted cardioverter-defibrillators are actually getting them, according to two studies in the Journal of the American Medical Association.

The devices, known as ICDs, “save lives, so the sex difference in treatment rates is worrisome,” said Lesley H. Curtis, a health economist at the Duke University Medical Center and lead author of one of the studies.

“We don’t know why the difference exists, but we do know that this is bad news for women,” added co-author Dr. Kevin A. Schulman of Duke, an internist and health policy expert.

As many as 450,000 Americans die each year when the electrical signals that initiate heartbeats become erratic, interfering with the organ’s ability to pump blood through the body. ICDs monitor the electrical impulses and, when they become irregular, shock the heart back into normal rhythms.

Clinical trials have shown that the devices, which are about the size of a cigarette pack and cost $30,000 to $40,000 to implant, can prolong life in 31 percent to 50 percent of patients who receive them.

Previous research

Previous research has shown a disparity between use of the devices in men and women but had suggested that the gap was closing. Today’s study, however, indicates it is getting wider.

“What it is showing ... is that we are not identifying women with heart disease,” said Dr. Jeffrey Goodman, a cardiologist at Cedars-Sinai Medical Center in Los Angeles who was not involved in the research.

“One thing that is very obvious is that, overall, we are underutilizing them in patients who meet the criteria,” he said. “Only 35 percent to 40 percent of people who meet the criteria are receiving appropriate therapy.”

In one study, Curtis and her colleagues studied a 5 percent sample of Medicare patients whose average age was 75.

One group of 136,421 patients had been diagnosed with a heart attack along with heart failure or cardiomyopathy, either of which left them susceptible to arrhythmia.

A second group of 99,663 patients had suffered either a cardiac arrest or cardiac arrhythmia.