Beschreibung:
<jats:sec xml:lang="en">
<jats:title>Background</jats:title>
<jats:p xml:lang="en">
Hypertrophic cardiomyopathy (
<jats:styled-content style="fixed-case">HCM</jats:styled-content>
) 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
<jats:styled-content style="fixed-case">HCM</jats:styled-content>
outcomes has not been examined.
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</jats:sec>
<jats:sec xml:lang="en">
<jats:title>Methods and Results</jats:title>
<jats:p xml:lang="en">
We conducted a retrospective cohort study that examined outcomes among
<jats:styled-content style="fixed-case">HCM</jats:styled-content>
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 (
<jats:styled-content style="fixed-case">LSES</jats:styled-content>
/
<jats:styled-content style="fixed-case">HSES</jats:styled-content>
) based on medical insurance provider and to receivers of specialty care (
<jats:styled-content style="fixed-case">SC</jats:styled-content>
) at Yale's Inherited Cardiomyopathy clinic or general cardiology care (
<jats:styled-content style="fixed-case">GC</jats:styled-content>
). The primary outcome was all‐cause death, and the secondary outcome was all‐cause hospitalization. We identified 953
<jats:styled-content style="fixed-case">HCM</jats:styled-content>
patients; 820 (86%) were
<jats:styled-content style="fixed-case">HSES</jats:styled-content>
and 133 (14%) were
<jats:styled-content style="fixed-case">LSES</jats:styled-content>
. Forty‐three (4.5%) patients died from cardiac and noncardiac causes.
<jats:styled-content style="fixed-case">LSES</jats:styled-content>
patients within the general cardiology care cohort had significantly higher all‐cause mortality compared with
<jats:styled-content style="fixed-case">HSES</jats:styled-content>
patients (adjusted hazard ratio, [95%
<jats:styled-content style="fixed-case">CI</jats:styled-content>
]=10.06 [4.38–23.09];
<jats:italic>P</jats:italic>
<0.001). This was not noted in the specialty care cohort (adjusted hazard ratio, [95%
<jats:styled-content style="fixed-case">CI</jats:styled-content>
]=2.87 [0.56–14.73];
<jats:italic>P</jats:italic>
=0.21). The moderator effect of specialty care on mortality difference between
<jats:styled-content style="fixed-case">LSES</jats:styled-content>
versus
<jats:styled-content style="fixed-case">HSES</jats:styled-content>
, however, did not reach statistical significance (hazard ratio, 0.29 [0.05–1.77];
<jats:italic>P</jats:italic>
=0.18). Specialist care was associated with increased hospitalization (adjusted hazard ratio, [95%
<jats:styled-content style="fixed-case">CI</jats:styled-content>
]=3.28 [1.11–9.73];
<jats:italic>P</jats:italic>
=0.03 for
<jats:styled-content style="fixed-case">LSES</jats:styled-content>
; 2.19 [1.40–3.40];
<jats:italic>P</jats:italic>
=0.001 for
<jats:styled-content style="fixed-case">HSES</jats:styled-content>
).
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<jats:title>Conclusions</jats:title>
<jats:p xml:lang="en">
Socioeconomically vulnerable
<jats:styled-content style="fixed-case">HCM</jats:styled-content>
patients had higher mortality when not referred to specialty care. Further study is needed to understand the underlying causes.
</jats:p>
</jats:sec>