Real-World Data on Inequity in Clinical Outcomes Among Adult Patients Diagnosed with Hypertrophic Cardiomyopathy

OBJECTIVES: Real-world evidence on inequities in the clinical course of hypertrophic cardiomyopathy (HCM) is limited. This research aims to assess equity in treatments and clinical outcomes of HCM in the year after first discharge.

METHODS: Adult patients with a discharge diagnosis of HCM during 4/2016- 3/2022 with a one-year follow-up data were analyzed in this retrospective cohort study utilizing data from the PINC AI^TM Healthcare Database, a large, all-payer, US hospital administrative database. The outcomes included septal reduction procedures (SRT), readmissions, heart failure and all-cause death in the year after first HCM discharge.

RESULTS: Overall, 109,604 patients with HCM were analyzed. Patients aged 65 years and older accounted for 53% of the total sample. The majority were female (52%), 19% were Black, 5.5% were Hispanic and 57% had Medicare. Social vulnerability index (SVI) was divided into quintiles, with the fifth quintile representing the highest vulnerability group. Overall, 13% were readmitted and 3.3% died within one year of first HCM discharge. Women, Black and the highest SVI group more frequently were prescribed beta blocker and calcium channel blocker. Adjusted for age, Black patients (60%), women (13%) and the highest SVI group (34%) were more likely to have heart failure or die within one year of index discharge than white, men and least SVI group respectively. They also had higher risk for readmissions, p <0.001. Women were 1.6 to 1.9 times more likely to have SRT and mitral valve procedures than men. Black patients and those in the highest SVI group had higher risk for renal failure while men frequently had atrial fibrillation, ventricular fibrillation/tachycardia and defibrillator implants.

CONCLUSIONS: This large-data study highlights sex, racial and social inequities in the clinical course of HCM. Recognizing the disparities can guide targeted interventions, thus improving heart function and overall quality of life.