For patients suffering from severe cardiomyopathy, which makes it hard for the heart to pump blood throughout the body, a device called an implantable cardioverter-defibrillator (ICD) can help the heart maintain a normal rhythm. However, many eligible patients do not receive an ICD – especially women and Black patients.
In a recent study published in the Journal of the American Heart Association, University of Pittsburgh researchers found that by using a best practice alert (BPA), providers increased overall rate of referrals to electrophysiologists and ICD implants. This study focused on how the referral and implantation rate improved for women and Black patients.
Data from prior clinical trials have shown that ICDs reduce death from any cause by decreasing the risk of sudden cardiac death among patients with severe cardiomyopathy. The American College of Cardiology, American Heart Association and Heart Rhythm Society recommend ICD implantation for these patients.
“We continue to see women and minorities referred less often for this life-saving treatment, despite knowledge that these disparities persist,” said Dr. Amber Johnson, UPMC cardiologist and co-author of the study. “The good thing about these best practice alerts is that they are based on clinical data alone – it’s not subjective – which may help providers overcome bias.”
By looking back at medical records, Johnson and her co-authors found that when a general practitioner or cardiologist saw a BPA pop up on their computer screen during an appointment with the patient, it significantly improved referral patterns for Black patients. Most striking was a 14 percent increase in the rate of electrophysiology referrals and a 16 percent increase in ICD implantations for Black patients compared with white patients, for whom the BPA did not lead to a significant change in referrals. They also found that BPAs reduced the gap between men and women getting referrals and implants – but it was not statistically significant.
“Best practice alerts have a role to play in leveling the playing field in ICD therapy,” said Dr. Samir Saba, an electrophysiologist and chief of the Division of Cardiology at Pitt’s School of Medicine. “By improving the rates of appropriate device referrals and implantations for all patients, these alerts de facto help close the racial and gender gaps in the delivery of this life-saving treatment.”
The study notes that there are several patient and provider barriers preventing people from receiving ICD therapy, including cost or insurance coverage issues, and inadequate physician education limiting a provider’s ability to identify eligible patients.
“With these promising results, we can examine whether BPAs could help narrow the gap between women and minorities for other devices, heart valve replacement and other guideline-indicated procedures,” said Johnson. “By using BPAs and other objective tools, we can help address bias and strive to achieve health care equity in cardiology and all medical disciplines.”