A final study population of 107,096 patients was identified from cases entered between 2006 and 2010. Of these, 87,692 (81.9%) received CRT-D. In the overall study population, the mean age was 70.7 years, 70.1% of the patients were male, and 83.8% were white. The mean LVEF was 23.7%. In the overall study population, the use of CRT-D in eligible patients significantly increased from 80.4% in the first year to 84.0% in the fourth year (p < 0.001) (Table 1). Among eligible whites, blacks, and Hispanics, there was a significant increase in CRT-D use over the study period. After adjusting for age, race, gender, atrial fibrillation/atrial flutter, cerebrovascular disease, chronic lung disease, diabetes, ischemic heart disease, duration of symptom since initial HF onset, prior hospitalizations for HF, previous myocardial infarction, LVEF, QRS duration, creatinine, sodium, brain natriuretic peptide, hospital owner, hospital region, electrophysiologist operator ICD training, physician volume, and the patients' clustering among hospitals in the hierarchical model, blacks and Hispanics remained less likely to receive CRT-D compared with whites (black vs. white odds ratio: 0.69; 95% confidence interval: 0.65 to 0.73, p < 0.001; Hispanic vs. white odds ratio: 0.84; 95% confidence interval: 0.78 to 0.91; p < 0.001). After adjustment, the effect of time on CRT-D use in eligible patients did not significantly vary according to the level of race/ethnicity (p = 0.68). In a sensitivity analysis of racial and ethnic subgroups restricted to Medicare patients only, the temporal trends among each subgroup persisted (whites: p < 0.001, blacks: p = 0.02), although these were not significant among Hispanics (p = 0.22).