Presentation (CTI)

OBJECTIVES: Commercially available US real-world data (RWD) often come from major provider networks, leading to underrepresentation of patients with lower socioeconomic status-of particular concern for studying cardiovascular disease (CVD) and other conditions characterized by disparities in care. Here, we investigate the characteristics of CVD patients in the Institute for Health Metrics’ insightsDB, which collates electronic medical record (EMR) data from ~100 predominantly rural US community hospitals.
METHODS: We characterized the burden of CVD in insightsDB by examining demographics, hospital outcomes, and procedures in patients with inpatient encounters for myocardial infarction (MI), congestive heart failure (CHF), and stroke in 2017-18. We then estimated mean differences for each characteristic between insightsDB hospitalizations and those in nationally-representative databases, Cerner RealWorldData (CRWD) EMR and the National Inpatient Sample (NIS), replicating Shah 2023 (DOI: 10.1016/j.ahj.2023.05.009).
RESULTS: Patients hospitalized for MI, CHF, and stroke in insightsDB were younger and more likely to be white and male compared to CRWD and the NIS. CVD hospitalizations in insightsDB were associated with shorter inpatient stays and fewer mortalities.
While CHF hospitalizations dominated CRWD and the NIS, MI hospitalizations were most frequent in insightsDB (47.1% of relevant hospitalizations, compared to 39.3% for stroke and 13.6% for CHF). Further, MI hospitalizations in insightsDB included proportionally more ST-segment elevation myocardial infarction (STEMI) events (mean difference vs CRWD = 6.1%; vs NIS = 8%), despite insightsDB having younger patients. Additionally, insightsDB MI hospitalizations had a lower proportion of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI).
CONCLUSIONS: Differences between insightsDB and nationally-representative RWD highlight the distinct profile of CVD patients treated in community hospitals. Proportionally more STEMI events and fewer PCIs and CABGs in the younger insightsDB population may indicate disparities in access to preventive care and treatments. Community hospital EMR provide an opportunity to investigate unique barriers to care in an underserved population.