Ismayl Mahmoud, Ahmed Hasaan, Goldsweig Andrew M, Eleid Mackram F, Guerrero Mayra
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA.
JACC Adv. 2024 Jul 3;3(7):101034. doi: 10.1016/j.jacadv.2024.101034. eCollection 2024 Jul.
Disparities in access to care cause negative health consequences for underserved populations. Economic disparities in structural heart disease (SHD) interventions are not well characterized.
The objective of this study was to evaluate economic disparities in the utilization and outcomes of SHD interventions in the United States.
We queried the National Inpatient Sample (2016-2020) to examine economic disparities in the utilization, in-hospital outcomes, length of stay, and cost of SHD interventions among patients ≥65 years of age. Outcomes were determined using logistic regression models.
A total of 401,005 weighted hospitalizations for transcatheter aortic valve replacement, left atrial appendage occlusion, transcatheter mitral valve repair, and transcatheter mitral valve replacement were included. Utilization rates (number of procedures performed per 100,000 hospitalizations) were higher in patients with high income compared with medium and low income for transcatheter aortic valve replacement (559 vs 456 vs 338), left atrial appendage occlusion (148 vs 136 vs 99), transcatheter mitral valve repair (65 vs 54 vs 41), and transcatheter mitral valve replacement (7.7 vs 6.7 vs 1.2) (all < 0.01). Low- and medium-income patients had distinctive demographic and clinical risk profiles compared with high-income patients. There were no significant differences in the adjusted in-hospital mortality, key complications, or length of stay between high-, medium-, and low-income patients following any of the 4 SHD interventions. High-income patients incurred a modestly higher cost with any of the 4 SHD interventions compared with medium- and low-income patients.
Economic disparities exist in the utilization of SHD interventions in the United States. Nonetheless, adjusted in-hospital outcomes were comparable among high-, medium-, and low-income patients. Multifaceted implementation strategies are needed to attenuate these utilization disparities.
获得医疗服务的差异会给服务不足的人群带来负面健康影响。结构性心脏病（SHD）干预措施中的经济差异尚未得到充分描述。
本研究的目的是评估美国SHD干预措施在使用情况和结果方面的经济差异。
我们查询了全国住院患者样本（2016 - 2020年），以研究65岁及以上患者在SHD干预措施的使用、住院结局、住院时间和费用方面的经济差异。使用逻辑回归模型确定结局。
总共纳入了401,005例经导管主动脉瓣置换术、左心耳封堵术、经导管二尖瓣修复术和经导管二尖瓣置换术的加权住院病例。经导管主动脉瓣置换术（559对456对338）、左心耳封堵术（148对136对99）、经导管二尖瓣修复术（65对54对41）和经导管二尖瓣置换术（7.7对6.7对1.2），高收入患者的使用率（每100,000例住院病例的手术例数）高于中等收入和低收入患者（均P < 0.01）。与高收入患者相比，低收入和中等收入患者具有独特的人口统计学和临床风险特征。在4种SHD干预措施中的任何一种之后，高收入、中等收入和低收入患者在调整后的住院死亡率、关键并发症或住院时间方面没有显著差异。与中等收入和低收入患者相比，高收入患者在4种SHD干预措施中的任何一种上的费用略高。
美国在SHD干预措施的使用方面存在经济差异。尽管如此，高收入、中等收入和低收入患者的调整后住院结局相当。需要多方面的实施策略来减少这些使用差异。
