Abstract 14682: Gender Disparities in Hypertrophic Cardiomyopathy After Septal Myectomy - Insights From the National Inpatient Sample 2011-2019

Abstract

Introduction: Data suggests that women with hypertrophic cardiomyopathy (HCM) have worse clinical outcomes than men. However, data from large multi-center studies on gender differences in patients who undergo septal myectomy (SM) is scarce. Methods: The National Inpatient Database was queried from 2011- 2019 for relevant ICD-9 and -10 diagnostic and procedural codes. We compared baseline characteristics and in-hospital outcomes of patients with HCM who underwent SM stratified according to male vs. female gender. A p-value <0.001 was considered statistically significant. Results: We identified 10,805 patients with HCM who underwent SM, of which 55.4% were female. Women were significantly older (60.9 vs. 56.3 years), had more obesity (31% vs. 26.8%), heart failure (44.6% vs. 40%), chronic obstructive pulmonary disease (12.2% vs. 9.2%) and pulmonary hypertension (16.2% vs. 11.5%) (p<0.001 for all) compared to men. Men had more hypertension (75.4% vs. 69.7%), tobacco use (41.5% vs. 34%), alcohol use (3.5% vs. 1.4%), hyperlipidemia (59.3% vs. 55.6%), obstructive sleep apnea (25.9% vs. 15%), coronary artery disease 41% vs. 32%), chronic kidney disease (12.6% vs. 8.7%), atrial fibrillation (46% vs. 40.9%), and atrial flutter (8.5% vs. 4.7%) (p<0.001 for all) compared to women. In-hospital outcomes demonstrate women had higher all-cause mortality (3.3% vs. 1.6%, OR: 2.4 [1.5-4]) and more frequently required intra-aortic balloon pump placement (OR: 6.9 [2.7-19]) compared to men. Men had more intraoperative cardiac complications (OR: 1.4 [1.1-1.6]), pneumothorax (OR: 1.7 [1.25-2.5]), and pericardial complications (OR: 10 [3-33]) (p<0.001 for all) compared to women. Conclusions: In patients with HCM who underwent SM, women had higher all-cause mortality despite having less comorbidities than men. These highlights potential gender differences in outcomes in patients referred for SM. Whether biases exist in referral patterns needs to be further elucidated.