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Spain's ICD implant rate is already well below the European average, and women make up just 18% of recipients. A new registry report highlights stark regional disparities — from 11.5% to 23.8% — raising questions about whether the gap reflects clinical reality or systemic bias. Experts say the answer likely lies in referral patterns and disease prevalence, not hospital-level discrimination.
Spain implanted 8,637 ICDs in 2025 at a rate of 182 per million inhabitants — well below the European average of 317 per million. A new report from the Heart Rhythm Association of the Spanish Society of Cardiology adds another layer of concern: women account for just 18% of those implants, with regional rates ranging from 11.5% in Navarre to 23.8% in Galicia.
Experts are divided on whether this gap signals a problem. Some cardiologists argue the numbers may be clinically appropriate — ischemic heart disease and heart failure with reduced ejection fraction (the primary ICD indications) are simply less common in women. Others worry the disparity could reflect upstream issues like delayed care-seeking, weaker referral networks, or fewer heart failure units in certain regions.
By the Numbers:
Why it matters: The data raises a critical question for cardiologists and health systems alike — are women being under-referred for a potentially life-saving device? Until a full national analysis of ICD indications is conducted, the answer remains unclear, but the call to investigate is growing louder.
