The Impact of Covid-19 on Implantable Cardioverter Defibrillator Implantation in Heart Failure Patients with Reduced Ejection Fraction

Abstract

The Impact of Covid-19 on Implantable Cardioverter Defibrillator Implantation in Heart Failure Patients with Reduced Ejection Fraction Emily Ryan, Rebecca Sparks-Thissen, Adrian Singson Background: Discrepancies in the utilization of implantable cardioverter defibrillators (ICD) in heart failure with reduced ejection fraction (HFrEF) patients is well documented. However, there is little real-world evidence investigating the impact of the Covid-19 pandemic on the utilization of ICDs in HFrEF patients. Study Objective/Hypothesis: The objective of this study was to assess how the Covid-19 pandemic impacted the odds of receiving an ICD implant in adult HFrEF patients. Methods: This study used data from the IU School of Medicine-Evansville RWEdataLab (CRC/Sidus Insights) Cardiology database, nationally sourced from de-identified electronic health record systems. Patients were filtered by adult age, HFrEF ICD-10 diagnosis codes, and presence or absence of ICD implant CPT codes. The pre-Covid and post-Covid periods were from June through November of 2018-2019 and 2022-2023, respectively. Patient groups were compared based on an initial HFrEF diagnosis and presence or absence of ICD implant during pre- and post-COVID periods. Results: Men and women were more likely to receive an ICD pre-Covid than post-Covid (OR 1.279, 95% CI (1.06-1.54) and OR 1.475, 95% CI (1.12-1.94), respectively). Men and women aged 71-80 received an ICD pre-Covid more than their post-Covid counterparts (OR 1.69, 95% CI (1.13-2.25) and OR 2.129, 95% CI (1.39-3.26)). More post-Covid men received an ICD than post-Covid women (OR 1.34, 95% CI (1.03-1.75)). Although there was no significant difference between all adult pre-Covid males versus females, males aged 81-90 received an ICD more than females (OR 1.707, 95% CI (1.21-2.40)). Conclusions: This study shows that Covid-19 reduced the odds of ICD utilization in HFrEF patients, especially older females. Future directions include investigating explanations for this healthcare inequity, including delayed medical procedures and increased mortality due to the pandemic. Further research should identify sources of age and gender disparities and minimize care inequities for older female HFrEF patients.