Open AccessAccess and Outcomes Among Hypertrophic Cardiomyopathy Patients in a Large Integrated Health System
Author(s) -
Thomas Alexander,
Papoutsidakis Nikolaos,
Spatz Erica,
Testani Jeffrey,
Soucier Richard,
Chou Josephine,
Ahmad Tariq,
Darr Umer,
Hu Xin,
Li Fangyong,
Chen Michael E.,
Bellumkonda Lavanya,
Sumathipala Adriel,
Jacoby Daniel
Publication year - 2020
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.119.014095
Subject(s) - medicine , hazard ratio , specialty , hypertrophic cardiomyopathy , cohort , retrospective cohort study , socioeconomic status , health care , emergency medicine , cardiology , confidence interval , population , family medicine , environmental health , economics , economic growth
Background Hypertrophic cardiomyopathy ( HCM ) is the most common inherited cardiomyopathy. Current guidelines endorse management in expert centers, but patient socioeconomic status can affect access to specialty care. The effect of socioeconomic status and specialty care access on HCM outcomes has not been examined. Methods and Results We conducted a retrospective cohort study that examined outcomes among HCM patients receiving care in the Yale New Haven Health System between June 2011 and December 2017. Patients were assigned to lower or higher socioeconomic status groups ( LSES / HSES ) based on medical insurance provider and to receivers of specialty care ( SC ) at Yale's Inherited Cardiomyopathy clinic or general cardiology care ( GC ). The primary outcome was all‐cause death, and the secondary outcome was all‐cause hospitalization. We identified 953 HCM patients; 820 (86%) were HSES and 133 (14%) were LSES . Forty‐three (4.5%) patients died from cardiac and noncardiac causes. LSES patients within the general cardiology care cohort had significantly higher all‐cause mortality compared with HSES patients (adjusted hazard ratio, [95% CI ]=10.06 [4.38–23.09]; P <0.001). This was not noted in the specialty care cohort (adjusted hazard ratio, [95% CI ]=2.87 [0.56–14.73]; P =0.21). The moderator effect of specialty care on mortality difference between LSES versus HSES , however, did not reach statistical significance (hazard ratio, 0.29 [0.05–1.77]; P =0.18). Specialist care was associated with increased hospitalization (adjusted hazard ratio, [95% CI ]=3.28 [1.11–9.73]; P =0.03 for LSES ; 2.19 [1.40–3.40]; P =0.001 for HSES ). Conclusions Socioeconomically vulnerable HCM patients had higher mortality when not referred to specialty care. Further study is needed to understand the underlying causes.