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Mistry A, Vali Z, Sidhu B, Budgeon C, Yuyun MF, Pooranachandran V, Li X, Newton M, Watts J, Khunti K, Samani NJ, Ng GA. Disparity in implantable cardioverter defibrillator therapy among minority South Asians in the United Kingdom. Heart 2020; 106:671-676. [PMID: 31924714 DOI: 10.1136/heartjnl-2019-315978] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE There are large geographical differences in implantable cardioverter defibrillator (ICD) implantation rates for reasons not completely understood. In an increasingly multiethnic population, we sought out to investigate whether ethnicity influenced ICD implantation rates. METHODS This was a retrospective, cohort study of new ICD implantation or upgrade to ICD from January 2006 to February 2019 in recipients of Caucasian or South Asian ethnicity at a single tertiary centre in the UK. Data were obtained from a routinely collected local registry. Crude rates of ICD implantation were calculated for the population of Leicestershire county and were age-standardised to the UK population using the UK National Census of 2011. RESULTS The Leicestershire population was 980 328 at the time of the Census, of which 761 403 (77.7%) were Caucasian and 155 500 (15.9%) were South Asian. Overall, 2650 ICD implantations were performed in Caucasian (91.9%) and South Asian (8.1%) patients. South Asians were less likely than Caucasians to receive an ICD (risk ratio (RR) 0.43, 95% CI 0.37 to 0.49, p<0.001) even when standardised for age (RR 0.75, 95% CI 0.74 to 0.75, p<0.001). This remained the case for primary prevention indication (age-standardised RR 0.91, 95% CI 0.90 to 0.91, p<0.001), while differences in secondary prevention ICD implants were even greater (age-standardised RR 0.49, 95% CI 0.48 to 0.50, p<0.001). CONCLUSION Despite a universal and free healthcare system, ICD implantation rates were significantly lower in the South Asian than the Caucasian population residing in the UK. Whether this is due to cultural acceptance or an unbalanced consideration is unclear.
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Affiliation(s)
- Amar Mistry
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Zakariyya Vali
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Bharat Sidhu
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Charley Budgeon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Matthew F Yuyun
- Department of Medicine, Harvard University, Boston, Massachusetts, USA.,Cardiology and Vascular Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
| | | | - Xin Li
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Michelle Newton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Jamie Watts
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - G Andre Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK .,Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, United Kingdom
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