Many eligible patients, particularly women and Black patients, do not obtain implantable cardioverter defibrillator (ICDs), indicated in patients with severe left ventricular dysfunction. A best practice alert (BPA) was previously shown to improve overall rates of electrophysiology referrals and ICD implantations. The impact of a BPA on sex and race was investigated in the study. This was a cluster-randomized trial with 106 cardiology and 89 primary care clinicians who were randomly assigned to receive (BPA, n=93) or not receive (No BPA, n=102) the alert and handled 1,856 patients who met primary prevention criteria for ICD placement (965 BPA and 891 No BPA). About 630 (34%) patients were sent to electrophysiology, and 522 (28%) patients received an ICD after a median follow-up of 34 months. Patients in the BPA arm had a slight differential increase in the rate of electrophysiological referrals at 18 months in men (+4%) compared to women (+7%) but a substantial rise in Black patients (+16%) vs White patients (+2%), thus closing the sex and race differences. Rates of ICD implantation followed a similar pattern. In all comers with severe cardiomyopathy and no prior ventricular arrhythmias, using a BPA enhances rates of electrophysiology referrals and ICD implantations. However, it had a more significant impact on women and Black patients. In the fight against sex and race inequities in health care, using a BPA at the point of care was a powerful strategy.
Source:www.ahajournals.org/doi/10.1161/JAHA.121.023669
