Study Examining Race, Heart Disease Treatments One of Eight USF Health Presentations Accepted to Prestigious Cardiology Conference
One of the studies found that African-Americans are more likely to have nonischemic heart disease than white patients, which points to the need for a risk-stratification system based on patients’ personal demographics.
Physicians often rely on a specific indicator of heart function to determine whether patients will receive implantable defibrillators — but the decision should hardly be so black and white.
Doctors should also take into account demographic information, namely race, for better insight into the causes of the patient’s heart condition and the likelihood he or she will benefit from a defibrillator.
That is the premise of “Differences Among African-Americans and White Patients Undergoing Implantable Cardioverter Defibrillator Implantation for Primary Prevention,” one of eight USF Health presentations accepted to the American College of Cardiology’s 66th Annual Scientific Session & Expo, which will take place in mid-March.
“As doctors, we’re taught to first do no harm,” said Vishal Parikh, MD, a USF Health Cardiovascular Sciences fellow and lead author of the paper.
“Part of doing no harm is not doing a procedure if it’s not necessary. That means taking the extra steps to see if a patient would truly benefit from a procedure, which is what this study is all about.”
Dr. Parikh and his co-authors, including internal medicine residents Kerolos Fahmi, MD, and Mrugesh Thakkar, MD, as well as USF Health Cardiovascular Sciences faculty members Sanders Chae, MD, lead senior author, Michael Fradley, MD, and Bengt Herweg, MD, conducted a retrospective chart review of 493 patients who received implantable cardioverter defibrillators (ICDs) between 2011 and 2016. An ICD is a small device placed in the chest that uses electrical shocks to help the heart maintain a healthy rhythm.
The researchers examined the demographic characteristics of the patients included in the sample, as well as their diagnoses with either ischemic or nonischemic heart disease. Ischemic is the result of blocked arteries. In nonischemic heart disease, there are no blockages; the heart becomes damaged through a variety of other causes, such as high blood pressure, infections, diabetes, drug reactions or genetics.
Dr. Parikh and team found that African-American patients in their sample were more likely to have nonischemic heart disease than white patients, 81.7 percent compared to 43.8 percent. African-Americans were also more likely to be morbidly obese and have high blood pressure and diabetes, and were less likely to have a history of heart bypass surgery, heart attacks and strokes.
Whether caused by ischemic or nonischemic disease, physicians use a patient’s ejection fraction — a measure of how much blood the heart is pumping — to determine whether he or she should receive an implantable defibrillator.
“In a normal heart, the ejection fraction is 55 percent or higher. Patients who have an ejection fraction of 35 or below are likely to get the device. It’s a fairly arbitrary cutoff,” Dr. Parikh said.
Prior studies, including most recently, “Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure,” published in The New England Journal of Medicine in 2016, have shown that implantable defibrillators do not decrease overall death in nonischemic heart disease.
Acknowledging that more research is needed, Dr. Parikh said the USF-authored paper points to the need for a risk-stratification system based on patients’ individual characteristics as well as data points such as ejection fraction.
“We are in an era of algorithmic medicine. We need to do further research to see if we can better individualize treatment and management of patients such as African-Americans. We may save them from an unnecessary procedure by running different tests or scans and focusing more on controlling the underlying causes of their heart disease more effectively,” Dr. Parikh said.
With eight presentations, USF Health will make its largest showing at the ACC Scientific Session & Expo since Arthur Labovitz, MD, became Cardiovascular Sciences chair in 2012.
“Selection of presentations at the ACC is a prestigious, peer-reviewed process and represents the newest and important developments in the field of cardiovascular diseases,” Labovitz said. “A showing of this magnitude at an important national meeting demonstrates the growth and prominence of USF Health in the detection and treatment of cardiovascular diseases, all of which impact the ability to support our mission of elevating the level of cardiovascular care in the Tampa Bay region.”
The complete list of USF presentations accepted to the ACC’s 66th Annual Scientific Session & Expo, listed here with their presenters and senior abstract authors, includes:
- “An Incidentally Detected Right Ventricular Pseudoaneurysm,” Vamsi Gaddipati, MD, a USF Health Cardiovascular Sciences fellow, Aarti Patel, MD
- “Global Longitudinal Strain (GLS) Imaging to Detect and Monitor Left Ventricular Function After Direct Cardiac Radiation,” Rongras Damrongwatanasuk, MD, a USF Health Cardiovascular Sciences fellow, Michael Fradley, MD
- “Everyone Should Be Able to Do an Echo Where and When It Is Needed,” Arthur Labovitz, MD
- “Clinical Characteristics and Changes of Valvuloarterial Impedence Severity in Patients Undergoing Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis,” Allan Chen, MD, Aarti Patel, MD, Fadi Matar, MD, Christiano Caldeira, MD, John Sullebarger, MD, Robert Hooker, MD, Arthur Labovitz, MD
- “Differences Among African Americans and White Patients Undergoing Implantable Cardioverter Defibrillator Implantation for Primary Prevention,” Vishal Parikh, MD, a USF Health Cardiovascular Sciences Fellow, Sanders Chae, MD, Michael Fradley, MD, and Bengt Herweg, MD
- “Successful Treatment of Checkpoint Inhibitor Induced Myocarditis and Cardiomyopathy with Steroids, Beta-Blockers and ACE Inhibitors,” Rongras Damrongwatanasuk, MD, a USF Health Cardiovascular Sciences fellow, Michael Fradley, MD
- “Patients Leaving Against Medical Advice: Can We Prevent Unnecessary Testing and Reduce Costs in the Evaluation of Acute Ischemic Heart Disease,” Michael Berlowitz, MD, Sanders Chae, MD
- “Cardiovascular Toxicities Associated with Adoptive Cell Therapy and Interleukin-2 Infusion for Advanced Stage Melanoma,” Michael Fradley, MD