Assessing Disparities in Cardiovascular Outcomes across Payers in Patients Diagnosed with Hypertrophic Cardiomyopathy

OBJECTIVES: There exists limited evidence on the association of payer coverage and cardiovascular (CV) outcomes in patients with hypertrophic cardiomyopathy (HCM). Therefore, we investigated these associations in a large, national cohort of patients with HCM.

METHODS: Retrospective cohort study of adults with HCM in Optum’s database (January 2013-December 2021). Incidence rates are reported for CV outcomes (atrial fibrillation [AF], stroke, heart failure [HF], ventricular tachycardia [VT], ventricular fibrillation [VF] and sudden cardiac arrest [SCA]) from first HCM diagnosis (index date) until death, health plan disenrollment, or study end. Kaplan-Meier survival analysis was conducted for 3-year all-cause mortality by payor type: Commercial (reference group), Medicare, Medicaid, Other, and unknown/ missing payer.

RESULTS: Among 24,586 HCM patients (mean age: 61.3±14.9 years; 49.0% female; mean follow-up: 43.9±28.5 months), 74.0% were non-Hispanic White and 19.6% were non-Hispanic Black/African American. Payer types were 45.4% commercial, 31.5% Medicare, 9.0% Medicaid, 13.6% Unknown/Missing, and 0.5% Other. Patients without commercial insurance were more likely to be prescribed beta-blockers and calcium channels blockers (p<0.001). Patients with Medicare were less likely to receive disopyramide and implantable cardioverter-defibrillators (p<0.001). Medicare and Medicaid patients were less likely to undergo septal myectomy and alcohol septal ablation (p<0.05). Medicare patients had greater rates of AF, stroke, HF, and SCA (p<0.001) and Medicaid patients had greater rates of stroke, HF, VT, SCA and VF (p<0.05). Patients with Other Payor types had greater rates of stroke and HF (p<0.01). All-cause mortality at 3 years was highest among Medicare patients (13.5%), followed by Unknown/missing (6.6%), Medicaid (6.0%), Other Payor (3.8%), and Commercial (3.4%) (p<0.001).

CONCLUSIONS: Patients with Medicare and Medicaid had greater rates of CV outcomes and all-cause mortality compared with commercially insured patients but were less likely to receive septal reduction therapy. Further research is needed to identify and address the sources of these associative disparities.