Disparities In Cardiovascular Outcomes Research Articles

Adherence to guideline-recommended care of late-onset hypertension in females versus males: A population-based cohort study.

Sex-based disparities in cardiovascular outcomes may be improved with appropriate hypertension management. To compare the evidence-based evaluation and management of females with late-onset hypertension compared to males in the contemporary era. Design: Retrospective population-based cohort study. Ontario, Canada. Residents aged ≥66 years with newly diagnosed hypertension between January 1, 2010, and December 31, 2017. Sex (female vs. male). We used Poisson and logistic regression to estimate adjusted sex-attributable differences in the performance of guideline-recommended lab investigations. We estimated adjusted differences in time to the prescription of, and type of, first antihypertensive medication prescribed between females and males, using Cox regression. Among 111,410 adults (mean age 73 years, 53% female, median follow-up 6.8 years), females underwent a similar number of guideline-recommended investigations (adjusted incidence rate ratio, 0.997 [95% confidence interval [CI] 0.99-1.002]) compared to males. Females were also as likely to complete all investigations (0.70% females, 0.77% males; adjusted odds ratio, 0.96 [95% CI 0.83-1.11]). Females were slightly less likely to be prescribed medication (adjusted hazard ratio [aHR] 0.98 [95% CI 0.96-0.99]) or, among those prescribed, less likely to be prescribed first-line medication (aHR, 0.995 [95% CI 0.994-0.997]). Compared to males, females with late-onset hypertension were equally likely to complete initial investigations with comparable prescription rates. These findings suggest that there may be no clinically meaningful sex-based differences in the initial management of late-onset hypertension to explain sex-based disparities in cardiovascular outcomes.

Trends and Disparities in Ambulatory Follow-Up After Cardiovascular Hospitalizations : A Retrospective Cohort Study.

Timely follow-up after cardiovascular hospitalization is recommended to monitor recovery, titrate medications, and coordinate care. To describe trends and disparities in follow-up after acute myocardial infarction (AMI) and heart failure (HF) hospitalizations. Retrospective cohort study. Medicare. Medicare fee-for-service beneficiaries hospitalized between 2010 and 2019. Receipt of a cardiology visit within 30 days of discharge. Multivariable logistic regression models were used to estimate changes over time overall and across 5 sociodemographic characteristics on the basis of known disparities in cardiovascular outcomes. The cohort included 1 678 088 AMI and 4 245 665 HF hospitalizations. Between 2010 and 2019, the rate of cardiology follow-up increased from 48.3% to 61.4% for AMI hospitalizations and from 35.2% to 48.3% for HF hospitalizations. For both conditions, follow-up rates increased for all subgroups, yet disparities worsened for Hispanic patients with AMI and patients with HF who were Asian, Black, Hispanic, Medicaid dual eligible, and residents of counties with higher levels of social deprivation. By 2019, the largest disparities were between Black and White patients (AMI, 51.9% vs. 59.8%, difference, 7.9 percentage points [pp] [95% CI, 6.8 to 9.0 pp]; HF, 39.8% vs. 48.7%, difference, 8.9 pp [CI, 8.2 to 9.7 pp]) and Medicaid dual-eligible and non-dual-eligible patients (AMI, 52.8% vs. 60.4%, difference, 7.6 pp [CI, 6.9 to 8.4 pp]; HF, 39.7% vs. 49.4%, difference, 9.6 pp [CI, 9.2 to 10.1 pp]). Differences between hospitals explained 7.3 pp [CI, 6.7 to 7.9 pp] of the variation in follow-up for AMI and 7.7 pp [CI, 7.2 to 8.1 pp]) for HF. Generalizability to other payers. Equity-informed policy and health system strategies are needed to further reduce gaps in follow-up care for patients with AMI and patients with HF. National Institute on Aging.

Reducing racial and ethnic disparities in cardiovascular outcomes among cancer survivors.

Analyze current evidence on racial/ethnic disparities in cardiovascular outcomes among cancer survivors, identifying factors and proposing measures to address health inequities. Existing literature indicates that the Black population experiences worse cardiovascular outcomes following the diagnosis of both initial primary cancer and second primary cancer, with a notably higher prevalence of cardio-toxic events, particularly among breast cancer survivors. Contributing socioeconomic factors to these disparities include unfavorable social determinants of health, inadequate insurance coverage, and structural racism within the healthcare system. Additionally, proinflammatory epigenetic modification is hypothesized to be a contributing genetic variation factor. Addressing these disparities requires a multiperspective approach, encompassing efforts to address racial disparities and social determinants of health within the healthcare system, refine healthcare policies and access, and integrate historically stigmatized racial groups into clinical research. Racial and ethnic disparities persist in cardiovascular outcomes among cancer survivors, driven by multifactorial causes, predominantly associated with social determinants of health. Addressing these healthcare inequities is imperative, and timely efforts must be implemented to narrow the existing gap effectively.

CO28 Assessing Disparities in Cardiovascular Outcomes across Payers in Patients Diagnosed with Hypertrophic Cardiomyopathy

CO28 Assessing Disparities in Cardiovascular Outcomes across Payers in Patients Diagnosed with Hypertrophic Cardiomyopathy

Sex-Related Disparities in Cardiovascular Outcomes Among Older Adults With Late-Onset Hypertension.

It is unclear whether sex-based differences in cardiovascular outcomes exist in late-onset hypertension. This is a population-based cohort study in Ontario, Canada of 266 273 adults, aged ≥66 years with newly diagnosed hypertension. We determined the incidence of the primary composite cardiovascular outcome (myocardial infarction, stroke, and congestive heart failure), all-cause mortality, and cardiovascular death by sex using Cox proportional hazard models adjusted for demographic factors and comorbidities. The mean age of the total cohort was 74 years, and 135 531 (51%) were female. Over a median follow-up of 6.6 (4.7-9.0) years, females experienced a lower crude incidence rate (per 1000 person-years) than males for the primary composite cardiovascular outcome (287.3 versus 311.7), death (238.4 versus 251.4), and cardiovascular death (395.7 versus 439.6), P<0.001. The risk of primary composite cardiovascular outcome was lower among females (adjusted hazard ratio, 0.75 [95% CI, 0.73-0.76]; P<0.001) than in males. This was consistent after adjusting for the competing risk of all-cause death with a subdistributional hazard ratio, 0.88 ([95% CI, 0.86-0.91]; P<0.001). Females had a lower risk of cardiovascular outcomes compared with males within a population characterized by advanced age and new hypertension. Our results highlight that the severity of outcomes is influenced by sex in relation to the age at which hypertension is diagnosed. Further studies are required to identify sex-specific variations in the diagnosis and management of late-onset hypertension due to its high incidence in this group.

Prevalence and Disparities of Cardiovascular Events and Outcomes of COVID-19 Patients Hospitalized with Multiple Myeloma: A National Inpatient Sample Analysis, 2020

Background: Major adverse cardiovascular events and all-cause mortality are higher and well-known complications of COVID 19 infection in cancer patients. However, considering limited data comparing the trends and outcomes in COVID-19 patients with and without multiple myeloma (MM), this population-based study evaluates the epidemiological trends and characteristics of sex, race, and co-morbidities to further understand the outcomes in COVID-19 patients hospitalized with or without Multiple Myeloma (MM). Methods: The US National Inpatient Sample for 2020 was assessed in hospitalized patients using relevant ICD-10 CM diagnostic codes and a retrospective cohort study was conducted. The cohort consisted of COVID19 patients which were then divided into two categories based on the occurrence of MM. The impact of COVID19 in the prevalence and outcomes of cardiovascular events in patients with and without MM was evaluated using multivariable regression analysis to assess the independent predictors of all-cause mortality. Results: We identified 1,659,035 COVID-19-related admissions, of which, 5240 (0.3%) patients had MM and 1,653,795 without MM. A median age was found to be 65 years in both the cohorts. Cohort with MM often consisted of male (57.5% vs. 52%), black (29.8% vs. 19.9%), Medicare enrollee (72.3% vs. 53%), admissions at urban teaching hospital (76% vs. 71.5%), non-electively admitted patients (96.3% vs 95.4%) compared to cohort without MM. Hypertension (73.4% vs 64.7%), prior MI (5.3% vs. 4.2 %), prior Venous thromboembolism (10.9% vs. 4.2%), CKD (41.2% vs. 20.6%), prior cancer (11.3% vs. 7.5%), prior chemotherapy (9.2% vs. 0.8%), prior radiation (3.7% vs. 0.9%), Higher length of stay (6 vs. 5 days); higher cost ($60475.59 vs. $47794.25) were also noted more frequently in MM cohort with significant p-value of &amp;lt;0.05. Whereas the cohort without MM consisted of higher proportion of females (48% vs. 42.5%), white (53.2% vs. 52.3%), Hispanics (22.5% vs. 14.8%), Asian or Pacific islanders (3.4% vs. 2.8%), Native Americans (1.1% vs. 0.3%), patients from lower household income (34.1% vs. 30.7%), Medicaid enrollees (15.1% vs. 7.0%), and patients with diabetes (40% vs. 36.5%), hyperlipidemia (39.7% vs. 37%), obesity (26.4% vs. 18.9%), peripheral vascular disease (4% vs. 3.4%), alcohol abuse (2.4% vs. 0.5%). MM patients were at increased risk of death during COVID19 hospitalizations, with equal risk amongst Male (22.2%) and Female (22.0%), compared to those without MM (p &amp;lt; 0.001). MM patients of Hispanic race were at increased risk of mortality during COVID-19 hospitalization (30.1%) (p&amp;lt;0.001). Additionally, MM patients of both sexes were at increased risk of mortality during COVID-19 hospitalizations given history of atrial fibrillation, with increased risk in Male patients (26.7 %) compared to Female patients (19.8 %) (p &amp;lt;0.001). Amongst different races, MM patients with atrial fibrillation of Hispanic race had increased mortality on COVID-19 hospitalizations (17.1%) compared to non-MM Hispanic patients (7.7%) (p &amp;lt;0.001). The MM group exhibited higher percentages of all-cause mortality (22.1% vs. 13.4%), acute myocardial infarction (5.6% vs. 4.5 %), atrial fibrillation (23.8% vs. 15.5%), heart failure with preserved ejection fraction (10.7% vs. 6.6%), heart failure with reduced ejection fraction (5.3% vs. 4.1%), and acute ischemic stroke (1.8% vs. 1.3%) without any significant difference for cardiac arrest. However, on multivariable regression analysis adjusted for covariates, there was no difference between all-cause mortality in COVID19 patients with MM vs. without MM (p = 0.230). Conclusions: Multiple Myeloma in COVID19 is associated with higher cardiovascular events and death during hospitalization, however, the study failed to show a statistically significant difference when adjusted for potential confounders. Prevailing sex and race-based disparities in cardiovascular outcomes in COVID19 patients with MM warrant future longitudinal studies. Clinical Implications: Clinicians can use this data to identify MM patients with COVID-19 to implement appropriate management strategies to reduce the adverse outcomes. Given the long-term complications and progression of MM, it remains crucial to understand the relationship and systemic effects of COVID-19 on patients with MM and impact of different risk factors and co-morbidities on long-term outcomes in post-COVID phase.

Abstract 17669: Prevailing Racial, Regional, and Income-Based Disparities in Cardiovascular Outcomes in Postmenopausal Women Hospitalized With SARS-CoV-2 in 2020

Introduction: Racial, regional, and income disparities have been shown to impact cardiovascular outcomes in postmenopausal women with SARS-CoV-2. Addressing these disparities can improve healthcare equity and outcomes for this vulnerable population. Methods: A retrospective cohort study utilized data from the National Inpatient Sample (NIS)-2020 to examine female patients aged over 55 years who were admitted to hospitals in 2020. The study focused on primary endpoints, specifically major cardiac and cerebrovascular events (MACCE) including all-cause mortality, AMI, cardiac arrest, and stroke. Multivariable logistic regression was used to evaluate the association between demographic factors and cardiovascular outcomes, after controlling for confounding variables. Results: Of the total 547,225 postmenopausal women hospitalized with SARS-CoV-2, 19.8% had MACCE. Racial disparities were significant, as Native American, Hispanic, Asian and African American women exhibited higher rates of MACCE compared to Caucasian women, with odds ratios (OR) of 1.63 (95% CI: 1.33-1.98, p&lt;0.001), 1.25 (95% CI: 1.18-1.32, p&lt;0.001), 1.17 (95% CI: 1.07-1.28, p&lt;0.001), and 1.11 (95% CI: 1.06-1.17, p&lt;0.001), respectively. Regional variations were also observed, with the Northeast region demonstrating a higher prevalence of cardiovascular complications compared to the West (OR: 1.22, 95% CI: 1.14-1.32, p&lt;0.001). Additionally, income level played a significant role, as women from the first- and second-income quartiles had higher MACCE rates compared to those in the fourth quartile (OR: 1.19, 95% CI: 1.12-1.26, p&lt;0.001; OR: 1.09, 95% CI: 1.03-1.15, p&lt;0.001). Conclusions: This study reveals significant racial, regional, and income disparities in cardiovascular outcomes among postmenopausal women with SARS-CoV-2. Targeted interventions and further research are necessary to improve healthcare equity and outcomes in vulnerable populations.

Abstract 13086: National Trends in Timely Ambulatory Follow-Up After Acute Myocardial Infarction and Congestive Heart Failure Cospitalizations Among Medicare Beneficiaries

Introduction: Following hospitalization for acute myocardial infarction (AMI) or congestive heart failure (CHF), close outpatient follow-up is warranted for symptom monitoring and initiation or titration of evidence-based therapies. Objective: To describe temporal trends in ambulatory care following CHF and AMI hospitalizations, between 2010 and 2019. Methods: We examined a 100% sample of Medicare fee-for-service beneficiaries discharged to the community after an AMI or CHF hospitalization. We assessed quarterly rates of timely post-discharge cardiology and primary care follow-up, defined as receipt of an ambulatory visit within 14 days of discharge. We assessed trends for five subgroups based upon known disparities in cardiovascular outcomes: sex, race/ethnicity, Medicaid dual-eligibility, county-level social deprivation index, and rurality. Results: The AMI cohort included 1,680,916 hospitalizations (54.9% male, 9.4% Black, 81.7% White) and the CHF cohort included 4,256,405 hospitalizations (47.7% male, 16.2% Black, 75.0% White). Timely cardiology follow-up after AMI increased from 26.8% in 2010 to 39.4% in 2019 (absolute change 12.6%) while follow-up after CHF increased from 22.0% to 33.4% (absolute change 11.5%). The proportion of patients without cardiology or primary care follow-up after AMI decreased to 36.1% in 2019 and to 41.6% for CHF. Though rates of timely follow-up increased for all demographic groups, female, Black, Hispanic, Medicaid dual-eligible patients, patients residing in rural areas, and patients residing in counties with high social deprivation were less likely to receive follow-up throughout the study. Conclusions: Rates of timely ambulatory care after AMI and CHF hospitalization have improved, but the majority of patients do not receive follow-up within 14 days of discharge. Efforts to improve post-hospital cardiology and primary care follow-up have the potential to improve clinical outcomes and reduce disparities.

Abstract 15337: Study of Relationship Between Neighborhood Racial Segregation and Heart Failure Mortality

Background Upstream factors, including socioeconomic status, healthcare access, structural environment, contribute to the presence of disparities in cardiovascular outcomes. The impact of neighborhood-level racial segregation on cardiovascular outcomes is not well understood. Research Question The goal of this study was to evaluate the association between neighborhood racial segregation and heart failure mortality. Methods/ Approach This is a retrospective, cohort study performed at Kaiser Permanente Southern California that included patients hospitalized for heart failure between January 2010 and December 2017. Data regarding demographics, comorbidities, and outcomes, was linked to the diversity index from the US Census Bureau. This is a measure of racial segregation, the likelihood that any two people from an area will be from different race/ ethnicity groups. The cohort was divided into tertiles by diversity index. Mortality rates for each racial group was calculated. Multivariate logistic regression models were constructed to evaluate the association between race/ethnicity and mortality. Results/ Data There were 19,322 patients included in our analysis. After adjusting for demographics, socioeconomic markers, neighborhood characteristics, and comorbidities, higher mortality was noted for Black patients compared to White patients in the least diverse tertile (adjusted OR [95% CI]: 1.42 [1.15-1.74]). In the most diverse tertile, no significant difference between Black and White patients was observed (adjusted OR [95% CI] 1.02 [0.83-1.26]). Asian and White patients did not show a difference in mortality across tertiles. Hispanic patients had a statistically significant decreased mortality in the two more diverse tertiles. Conclusion: Heart failure mortality is lower in Black patients in more diverse neighborhoods. Further work is needed to look at the pathway that connects racial segregation to heart failure outcomes.

A-23 | Gender Disparities in Cardiovascular Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusions

Several studies have demonstrated the utility of percutaneous coronary intervention (PCI) in improving cardiovascular outcomes in patients with chronic total occlusions (CTOs). However, the differences in clinical outcomes based on gender have not been well elucidated. This meta-analysis aims to evaluate the differences in cardiovascular outcomes of CTO PCI based on gender. A literature search was conducted for studies reporting on clinical endpoints after CTO PCI based on gender. The primary endpoint was all-cause mortality. Secondary endpoints included procedural success, recurrent acute myocardial infarction (AMI), and composite major adverse cardiovascular events (MACE). The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. A total of 14 studies with 15,129 patients with CTO PCIs (2804 females, 12325 males) met inclusion criteria. Mean follow-up was 48 months. Female gender was associated with a trend toward higher risk of all-cause mortality and MACE and lower procedural success; however, this was not statistically significant (OR 1.2, 95% CI 0.98-1.48; p=0.08; OR 1.26, 95% CI 0.99-1.59; p=0.06; OR 1.12, 95% CI 0.98-1.27; p=0.08). There was no significant difference in the risk of recurrent AMI on long-term follow-up post-PCI in females compared to males (OR 1.07, 95% CI 0.82-1.40; p=0.61). Female patients who undergo CTO PCI have similar procedural success without increased risk of long-term all-cause mortality, MACE, or recurrent AMI compared to male patients.

Abstract P653: Cardiac Rehabilitation Participation is Associated With Lower Risk of Major Adverse Cardiovascular Events Across Race or Ethnicity and Income

Introduction: Cardiac rehabilitation (CR) participation reduces the likelihood of major adverse cardiovascular events (MACE), but is limited by structural factors, including race or ethnicity and annual income. We investigated (1) associations between CR participation and MACE, and (2) how structural disadvantage modifies this association, focusing on the intersection between race or ethnicity and household income. Hypotheses: We hypothesized that (1) CR participation would be inversely associated with MACE, and (2) this association would attenuate differences in MACE by race or ethnicity, as well as by household income. Methods: We identified 212,744 individuals with a CR-qualifying event between 1/1/16 and 12/31/20 in Optum’s de-identified Clinformatics® Data Mart database. We evaluated associations between CR sessions attended (0 to 36) and MACE (cardiac arrest, heart failure, myocardial infarction, or stroke hospitalizations) using a proportional hazards model for recurrent events, and assessed the three-way interaction between CR participation, race or ethnicity, and household income. Results: We included 212,744 individuals (age 70.8±11.3 years; 37.8% female sex; 71.9% White race) of whom 26.0% attended ≥1 CR sessions. Overall, we observed a dose-response association between CR participation and MACE. After adjustment, those who did not attend CR were 2.9 times as likely to experience MACE as those who attended ≥36 sessions (95% CI: 2.71, 3.03, P &lt;0.0001), for whom there were no significant differences by race or ethnicity ( Figure ). Associations between CR participation and MACE were similar both across race or ethnicity and by household income ( P , interaction=0.28). Conclusion: Greater CR participation is associated with lower risk of MACE, regardless of (1) race or ethnicity and (2) household income. Because participation in CR remains low, particularly in socially disadvantaged populations, interventions to promote use of CR are critical to reduce disparities in cardiovascular outcomes.

Abstract P573: Educational Assortative Mating and Cardiovascular Outcomes

Objective: To estimate the association between educational assortative mating and cardiovascular outcomes among postmenopausal women in the Women’s Health Initiative study. Background: Between 1970 and 2015, the number of dual professional couples almost tripled. For instance, the likelihood of male attorneys marrying female lawyers and male doctors marrying female doctors has increased. Studies have proposed that educational assortative mating—people marry those with similar educational attainment--affects health disparities through increasing income inequality, creating differential levels of healthcare access, and based on the social cognitive theory, exchanging health knowledge and sharing healthy behaviors. Methods: We compared women living in three homogenous educational pairings; married women and spouses who both have 1) a high school degree or lower, 2) an associate or college degree, and 3) an MS, Ph.D., or professional degree. We used logistic regression models for prevalent outcomes (HTN, CHD, HF) at WHI baseline and Cox proportional hazard regression models for incident outcomes, all adjusted for age and total household income. To consider effect modification by membership in different racial or ethnic groups, we also conducted a stratified analysis. Results: We found significant associations between educational assortative mating and all cardiovascular outcomes within all groups of women. We found higher odds of prevalent cardiovascular outcomes ranging from 47 to 98 percent and a higher hazard of incident outcomes ranging from 24 to 56 percent. The strongest associations were found for prevalent and incident heart failure among Black women. Conclusion: This study provides evidence that educational assortative mating is likely a contributor to widening disparities in cardiovascular outcomes within and between racial groups of women.

Sex differences and disparities in cardiovascular outcomes of COVID-19.

Previous analyses on sex differences in case fatality rates at population-level data had limited adjustment for key patient clinical characteristics thought to be associated with coronavirus disease 2019 (COVID-19) outcomes. We aimed to estimate the risk of specific organ dysfunctions and mortality in women and men. This retrospective cross-sectional study included 17 hospitals within 5 European countries participating in the International Survey of Acute Coronavirus Syndromes COVID-19 (NCT05188612). Participants were individuals hospitalized with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from March 2020 to February 2022. Risk-adjusted ratios (RRs) of in-hospital mortality, acute respiratory failure (ARF), acute heart failure (AHF), and acute kidney injury (AKI) were calculated for women vs. men. Estimates were evaluated by inverse probability weighting and logistic regression models. The overall care cohort included 4499 patients with COVID-19-associated hospitalizations. Of these, 1524 (33.9%) were admitted to intensive care unit (ICU), and 1117 (24.8%) died during hospitalization. Compared with men, women were less likely to be admitted to ICU [RR: 0.80; 95% confidence interval (CI): 0.71-0.91]. In general wards (GWs) and ICU cohorts, the adjusted women-to-men RRs for in-hospital mortality were of 1.13 (95% CI: 0.90-1.42) and 0.86 (95% CI: 0.70-1.05; pinteraction = 0.04). Development of AHF, AKI, and ARF was associated with increased mortality risk (odds ratios: 2.27, 95% CI: 1.73-2.98; 3.85, 95% CI: 3.21-4.63; and 3.95, 95% CI: 3.04-5.14, respectively). The adjusted RRs for AKI and ARF were comparable among women and men regardless of intensity of care. In contrast, female sex was associated with higher odds for AHF in GW, but not in ICU (RRs: 1.25; 95% CI: 0.94-1.67 vs. 0.83; 95% CI: 0.59-1.16, pinteraction = 0.04). Women in GW were at increased risk of AHF and in-hospital mortality for COVID-19 compared with men. For patients receiving ICU care, fatal complications including AHF and mortality appeared to be independent of sex. Equitable access to COVID-19 ICU care is needed to minimize the unfavourable outcome of women presenting with COVID-19-related complications.

Abstract 11122: Sex Differences and Disparities in Cardiovascular Outcomes of Covid-19

Introduction: Previous analyses on sex differences in case-fatality rates at population-level data had limited adjustment for key patient clinical characteristics thought to be associated with COVID-19 outcomes. Hypothesis: We aimed to estimate the risk of specific organ dysfunctions and mortality in women and men. Methods: This retrospective cross-sectional study included 17 hospitals within 5 European countries participating in the International Survey of Acute Coronavirus Syndromes (ISACS) COVID-19 (NCT05188612). Participants were individuals hospitalized with positive SARS-CoV-2 from March 2020 to February 2022. Risk-adjusted ratios (RR) of in-hospital mortality, acute respiratory failure (ARF), acute heart failure (AHF), and acute kidney injury (AKI) were calculated for women versus men. Estimates were evaluated by inverse probability of weighting and logistic regression models Results: The overall care cohort included 4,499 patients with COVID-19 associated hospitalizations. Of these, 1,524 (33.9%) were admitted to ICU, and 1,117 (24.8%) died during hospitalization. Compared with men, women were less likely to be admitted to ICU (RR: 0.80; 95%CI: 0.71-0.91). In general wards and ICU cohorts, the adjusted women-to-men RRs for in-hospital mortality were of 1.13 (95%CI: 0.90-1.42) and 0.86 (95%CI: 0.70-1.05; p interaction =0.04). Development of AHF, AKI, and ARF was associated with increased mortality risk (OR: 2.27; 95%CI; 1.73-2.98, OR: 3.85; 95%CI: 3.21-4.63 and OR: 3.95; 95%CI: 3.04-5.14, respectively). The adjusted RRs for AKI and ARF were comparable among women and men regardless of intensity of care. By contrast, female sex was associated with higher odds for AHF in general wards, but not in ICU (RRs: 1.25;9 5%CI: 0.94-1.67 versus 0.83; 95%CI: 0.59-1.16, p interaction =0.04). Conclusions: Women in general wards were at increased risk of AHF and in-hospital mortality for COVID-19 compared with men. For patients receiving ICU care, fatal complications including AHF and mortality appeared to be independent of sex. Equitable access to COVID-19 ICU care is needed to minimize the unfavourable outcome of women presenting with COVID-19 related complications.

S899 Sex and Racial Disparities in Cardiovascular Disease Risk and Major Adverse Cardiac and Cerebrovascular Events in NAFLD: A National Inpatient Sample Analysis (2019)

Introduction: Non Alcoholic Fatty Liver Disease (NAFLD) increases the risk of CVD independently of the conventional cardiovascular risk factors. However, related sex and racial disparities in cardiovascular outcomes remain poorly understood on the large scale. This prompted us to attempt an investigation between the association of NAFLD and major cardiovascular and cerebrovascular events [MACCE] using a nationally representative sample in the US. Methods: We curated National Inpatient Sample (2019) for NAFLD hospitalizations stratified by age, sex and race using ICD-10 codes. Baseline characteristics, comorbidities, and MACCE:all-cause mortality, acute myocardial infarction (AMI), cardiac arrest and stroke were compared between groups stratified by sex and race. Multivariate regression analyses were performed adjusting for sociodemographics, hospitalization characteristics and comorbidities. Results: Our study included 409,130 NAFLD hospitalizations [median 55 (IQR 43-66) years. The prevalence of NAFLD was higher in females vs males (1.2%), Hispanic (2%), Native Americans (1.9%) vs white. Median age of females was 55 years (IQR 42-67), were often from lowest income quartile, Medicare enrollees, and had non-elective admissions. Females demonstrated lower rates of hypertension, hyperlipidemia, complicated diabetes but higher rates of obesity and uncomplicated diabetes vs. males. Median age of Hispanics was 48 years (IQR 37-60), majority of them belonged to the lowest income quartile, Medicaid enrollees, and underwent non elective admissions. Hispanics exhibited lower frequency of hypertension, hyperlipidemia but higher rates of diabetes and obesity vs. whites. Geriatric patients had higher risk of MACCE (aOR 3.01), all-cause mortality (aOR 4.13), Acute MI (aOR 2.81), Cardiac arrest (aOR 2.24) and Stroke (aOR 2.58) (p< 0.001). Males had greater risk of MACCE (aOR 1.22), AMI (aOR 1.35) and Cardiac arrest (aOR 1.54) (p< 0.001). By race, Native Americans (aOR 1.64) followed by Asian Pacific Islanders(API) (aOR 1.18) had significantly higher odds of all-cause mortality vs whites (Table). Conclusion: NAFLD is associated with adverse MACCE especially with increasing age and male sex. Native Americans followed by API race was associated with higher odds of all-cause mortality. This study reiterates the interplay between NAFLD and cardiovascular/cerebrovascular diseases and highlights prevailing sex/racial disparities in outcomes warranting tailored care. Table 1. - Multivariable Odds of Major Adverse Cardiac and Cerebrovascular Events in NAFLD patients by Age, Sex, and Race, 2019 Categories MACCE All cause mortality Acute MI Cardiac arrest Stroke 18-44 ref ref ref ref ref 45-64 2.31 (2.06-2.59) 3.00 (2.42-3.72) 2.23 (1.87-2.66) 2.08 (1.55-2.80) 1.90 (1.52 – 2.38) >=65 3.01 (2.61-3.47) 4.13 (3.11-5.48) 2.81 (2.29-3.45) 2.24 (1.52-3.31) 2.58 (1.96-3.39) p< 0.001 p< 0.001 p< 0.001 p< 0.001 p< 0.001 Male vs Female 1.22 (1.14-1.30) 1.04 (0.92-1.18) 1.35 (1.24-1.48) 1.54 (1.26-1.88) 1.04 (0.91-1.19) P-values < 0.001 0.539 < 0.001 < 0.001 0.579 White ref ref ref ref ref Black 1.00 (0.90-1.11) 0.89 (0.72-1.10) 0.95 (0.81-1.11) 1.16 (0.86-1.57) 1.25 (1.03-1.53) Hispanic 0.88 (0.79-0.98) 0.69 (0.56-0.85) 0.93 (0.81-1.08) 0.75 (0.55-1.02) 1.07 (0.87-1.31) API 1.06 (0.86-1.30) 1.18 (0.82 – 1.89) 1.06 (0.81-1.38) 0.77 (0.42-1.43) 0.99 (0.69-1.42) NA 1.14 (0.81-1.61) 1.64 (1.04-2.60) 0.91 (0.53-1.56) 0.74 (0.25-2.15) 0.84 (0.41-1.81) Others 1.11 (0.92 -1.34) 0.91 (0.62-1.33) 1.33 (1.06-1.67) 1.05 (0.62-1.78) 0.99 (0.68-1.45) P-values 0.125 0.001 0.121 0.272 0.377 MACCE - Major Adverse Cardiovascular and Cerebrovascular Events API - Asian Pacific Islanders NA - Native Americans.Multivariate regression models were adjusted for Age, sex, race, household income quartile, payer status, type of admission, hospital bed size, location/teaching status, region, comorbidities including HTN DM HLD obesity, smoking, PVD, PriorMI PriorPCI PriorCABG, drug abuse, prior stroke/TIA, prior VTE.

The Impact of the Affordable Care Act on Disparities in Utilization of Cardiovascular Preventive Services by Socioeconomic Status.

Disparities in cardiovascular outcomes are persistent in our society. The objective was to track the trends before and after the passage of the Affordable Care Act in socioeconomic status (SES) disparities in utilization of cardiovascular disease (CVD) preventive services among nonelderly adults aged 18-64 years. This study used the National Health Interview Survey (2011-2017) to compare utilization of blood pressure, cholesterol, glycemic screening, and diet and smoking cessation advice over time between groups stratified by SES and race using difference-in-difference analysis. This study also measured the differences over time in specific vulnerable population subgroups (Hispanic, low-income and uninsured vs. White, middle-high-income, and insured). The study population included 176,961 surveyed individuals (mean age 40 [±13] years; 51% female; 67.7% non-Hispanic White) between 2011 and 2017, translating to 194.8 million nonelderly US adults per year. Most individuals were from high-income SES (40.0%), followed by middle-income (28.1%), low-income (13.6%), and lowest income SES (18.3%). The proportion of CVD preventive services increased over all SES categories through the study period. The biggest relative changes were seen among low-income individuals. The difference in blood pressure checks, cholesterol checks, and smoking cessation advise between high- and lowest income groups showed a statistically significant decrease at 5.2%, 4.8%, and 11.2%, respectively, between 2011 and 2017. The findings demonstrate a trend in reduction of CVD preventive care disparities between SES groups. However, a gap still exists, and this study highlights the need for continuous improvement to eliminate SES disparities.

Inpatient cardiac care for acute coronary syndromes in the Top End of Australia.

Disparities in cardiovascular outcomes between Aboriginal and Torres Strait Islander Australians and non-Indigenous Australians persist. This has previously been attributed to a combination of differences in burden of cardiovascular disease risk factors, and inpatient access to guideline-recommended care. To assess differences in inpatient access to guideline-recommended acute coronary syndrome (GR-ACS) treatment between Aboriginal and Torres Strait Islander and non-indigenous patients admitted to Royal Darwin Hospital (RDH) with index ACS event. This retrospective study included index ACS admissions (n = 288) to RDH between January 2016 and June 2017. Outcomes included rates of coronary angiography, percutaneous coronary intervention (PCI), surgical revascularisation, GR-ACS medications prescribed on discharge and short-term outcomes (30-day mortality and ACS readmissions; 12-month all cardiac-related readmissions). Two hundred and eighty-eight patients, including 109 (37.85%) Aboriginal and Torres Strait Islander patients, were included. Compared with non-indigenous patients, they were younger (median age 48 years vs 60 years; P < 0.01), with a greater burden of comorbidities, including diabetes (39% vs 19%; P < 0.01), smoking (68% vs 35%; P < 0.01) and chronic kidney disease (29% vs 5%; P < 0.01). There were no differences in rates of coronary angiography (98% vs 96%; P = 0.24) or PCI (47% vs 57%; P = 0.12), although there was a trend towards surgical revascularisation in Aboriginal and Torres Strait Islander patients (16% vs 8%; P = 0.047). There were no differences in 30-day mortality (1.8% vs 1.7%; P = 0.72), 12-month ACS readmissions (7% vs 4%; P = 0.20) or 12-month cardiac-related readmissions (7% vs 13%; P = 0.11). Aboriginal and Torres Strait Islander patients received similar inpatient ACS care and secondary prevention medication at discharge, with similar short-term mortality outcomes as non-indigenous patients. While encouraging, these outcomes may not persist long term. Further outcomes research is required, with differences compelling consideration of other primary and secondary prevention contributors.

Racial and Socioeconomic Disparities in Cardiovascular Outcomes of Preeclampsia Hospitalizations in the United States 2004-2019

BackgroundPreeclampsia is associated with higher in-hospital cardiovascular events and mortality with known disparities by race/ethnicity, but data on the interaction between income and these outcomes remain limited. ObjectivesThis study investigated racial and socioeconomic disparities in cardiovascular outcomes of preeclampsia at delivery hospitalizations. MethodsWe analyzed National Inpatient Sample data using International Classification of Diseases-9th Revision/-10th Revision codes between 2004 and 2019. We identified a total of 2,436,991 delivery hospitalizations with preeclampsia/eclampsia as a primary diagnosis representing White (43.1%), Black (18.4%), Hispanic (18.7%), and Asian or Pacific Islander (A/PI; 3.3%) women. We stratified the population based on median household income (low income, medium income, and high income). Logistic regression and propensity-matched analysis were used for reporting outcomes adjusted for age, hospital region, and baseline comorbidities. ResultsBlack Hispanic, and A/PI women with preeclampsia had higher in-hospital mortality compared with White women across all groups of income. Hispanic women had lower odds of peripartum cardiomyopathy (PPCM) compared with White women. A significant interaction effect was observed with race/ethnicity and median household income for in-hospital mortality and PPCM with preeclampsia. Furthermore, high-income Black women had higher odds of PPCM, stroke, acute kidney injury, heart failure, cardiac arrhythmia, and venous thromboembolism compared with low-income White women. ConclusionsWomen with preeclampsia experience significant racial/ethnic and socioeconomic disparities in inpatient mortality and cardiovascular outcomes at delivery. Across all income groups, Black, Hispanic, and A/PI women experience higher odds of in-hospital mortality compared with White women. Furthermore, high-income Black women had greater odds of many CV complications compared with low-income White women.

Cardiovascular disease risk in women living with HIV.

To synthesize current evidence on the impact of cardiovascular disease among women living with HIV (WLWH) with a particular focus on disease prevalence, mechanisms and prevention. HIV-related cardiovascular disease risk is 1.5-fold to 2-fold higher for women than for men. Mechanisms of enhanced risk are multifactorial and include reinforcing pathways between traditional risk factors, metabolic dysregulation, early reproductive aging and chronic immune activation. These pathways influence both the presentation of overt syndromes of myocardial infarction, stroke and heart failure, as well as subclinical disease, such as microvascular dysfunction and cardiac fibrosis. Cardiovascular disease, therefore, remains a consistent threat to healthy aging among WLWH. Although no specific prevention strategies exist, patient-centered risk mitigation approaches that are adaptable to the needs of aging individuals are essential to combat disparities in cardiovascular outcomes among WLWH. Further research into the optimal prevention approach for CVD among WLWH, particularly for women living in under-resourced health systems, is needed.

Disparities in cardiovascular outcomes among emergency department patients with mental illness

BackgroundPatients with mental illness have been shown to receive lower quality of care and experience worse cardiovascular (CV) outcomes compared to those without mental illness. This present study examined mental health-related disparities in CV outcomes after an Emergency Department (ED) visit for chest pain. MethodsThis retrospective cohort included adult Medicaid beneficiaries in Washington state discharged from the ED with a primary diagnosis of unspecified chest pain in 2010–2017. Outcomes for patients with any mental illness (any mental health diagnosis or mental-health specific service use within 1 year of an index ED visit) and serious mental illness (at least two claims (on different dates of service) within 1 year of an index ED visit with a diagnosis of schizophrenia, other psychotic disorder, or major mood disorder) were compared to those of patients without mental illness. Our outcomes of interest were the incidence of major adverse cardiac events (MACE) within 30 days and 6 months of discharge of their ED visit, defined as a composite of death, acute myocardial infarction (AMI), CV rehospitalization, or revascularization. Secondary outcomes included cardiovascular diagnostic testing (diagnostic angiography, stress testing, echocardiography, and coronary computed tomography (CT) angiography) rates within 30 days of ED discharge. Only treat-and-release visits were included for outcomes assessment. Hierarchical logistic random effects regression models assessed the association between mental illness and the outcomes of interest, controlling for age, gender, race, ethnicity, Elixhauser comorbidities, and health care use in the past year, as well as fixed year effects. ResultsThere were 98,812 treat-and-release ED visits in our dataset. At 30 days, enrollees with any mental illness had no differences in rates of MACE (AOR 0.96; 95% CI, 0.72–1.27) or any of the individual components. At 6 months, enrollees with any mental illness (AOR 1.86; 95% CI, 1.11–3.09) and serious mental illness (AOR 2.60; 95% CI 1.33–5.13) were significantly more likely to be hospitalized for a CV condition compared to those without mental illness. Individuals with any mental illness had higher rates of testing at 30 days (AOR 1.16; 95% CI 1.07–1.27). ConclusionPatients with mental illness have similar rates of MACE, but higher rates of certain CV outcomes, such as CV hospitalization and diagnostic testing, after an ED visit for chest pain.