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Original research
Disparity in implantable cardioverter defibrillator therapy among minority South Asians in the United Kingdom
  1. Amar Mistry1,2,
  2. Zakariyya Vali1,2,
  3. Bharat Sidhu1,2,
  4. Charley Budgeon1,
  5. Matthew F Yuyun3,4,
  6. Vivetha Pooranachandran1,
  7. Xin Li1,
  8. Michelle Newton1,
  9. Jamie Watts1,
  10. Kamlesh Khunti5,
  11. Nilesh J Samani1,2,6,
  12. G Andre Ng1,2,6
  1. 1 Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
  2. 2 Department of Cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
  3. 3 Department of Medicine, Harvard University, Boston, Massachusetts, USA
  4. 4 Cardiology and Vascular Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
  5. 5 Diabetes Research Centre, University of Leicester, Leicester, UK
  6. 6 National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester, United Kingdom
  1. Correspondence to Professor G Andre Ng, Department of Cardiovascular Sciences, University of Leicester, Leicester LE3 9QP, UK; gan1{at}


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.

  • implanted cardiac defibrillators
  • cardiac arrhythmias and resuscitation science
  • health care delivery

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  • Contributors All authors read, approved and contributed significantly to the work. GAN and NJS conceived the study. AM was responsible for planning the study, reviewing the literature, conducting the data collection and writing the manuscript. ZV and BS contributed to the data collection and writing of the manuscript. MFY contributed to the statistical analysis and writing of the manuscript. CB carried out the statistical analysis. VP, MN, XL, JW, KK, NJS and GAN contributed to the writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the institution’s review board and conducted as a local audit. According to the Health Research Authority (HRA) decision algorithm, the study was not classified as research requiring formal HRA or a research ethics committee review.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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