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Utilization of Cardiovascular Procedures, Consultation Services, and Cardioprotective Medications Among Type 2
Harsh Goel1, Meera V Kapadia2, Karan V Goenka2
1Department of Cardiovascular Disease, The University of Texas Health Science Center, Houston McGovern Medical School, Houston, Texas, USA.
Insights
Patients with type 2 myocardial infarction (T2MI) in the U.S. received significantly less cardiovascular testing and secondary preventative therapies compared to type 1 myocardial infarction (T1MI) patients. This highlights disparities in care for T2MI individuals.
Area of Science:
- Cardiology
- Health Services Research
- Public Health
Background:
- Type 2 myocardial infarction (T2MI) is associated with coronary atherosclerosis and recurrent cardiovascular events.
- Understanding cardiovascular resource utilization in T2MI patients is crucial but remains unclear.
Purpose of the Study:
- To characterize and compare cardiovascular resource utilization between T2MI and type 1 myocardial infarction (T1MI) patients in the United States.
Main Methods:
- A retrospective analysis of de-identified data from Optum's Clinformatics Data Mart Database (October 2017–June 2020).
- Comparison of cardiovascular procedures, physician services, and prescriptions within 6 months postdischarge between T2MI and T1MI cohorts.
- Multivariable logistic regression to assess odds of utilization and identify predictors in T2MI patients.
Main Results:
- The study included 140,344 myocardial infarction patients (13% T2MI, 87% T1MI).
- T2MI patients were significantly less likely to receive P2Y12 inhibitors, beta blockers, statins, SGLT2i/GLP-1 agonists, echocardiograms, and coronary angiograms compared to T1MI patients.
- Adjusted odds ratios showed significantly lower utilization of these therapies and diagnostic procedures for T2MI patients.
Conclusions:
- T2MI patients in the U.S. receive less cardiovascular testing and secondary preventative therapies than T1MI patients.
- Findings suggest potential disparities in care for T2MI patients warranting further investigation and intervention.
Background:
Coronary atherosclerosis and recurrent cardiovascular events are common among individuals with type 2 myocardial infarction (T2MI). However, cardiovascular resource utilization among T2MI patients is unclear.
Objectives:
The aim of the study was to characterize cardiovascular resource utilization among T2MI patients across the United States.
Methods:
Using Optum's de-identified Clinformatics Data Mart Database, cardiovascular procedures, physician services, and prescriptions within 6 months postdischarge were compared among patients with T2MI vs type 1 myocardial infarction (T1MI) between October 1, 2017, and June 30, 2020. Multivariable logistic regression examined the odds of resource utilization in T2MI vs T1MI and identified predictors of utilization for T2MI.
Results:
We identified 140,344 patients with myocardial infarction; 121,738 patients (87%) had T1MI and 18,606 (13%) had T2MI. All participants had 183 days of postdischarge follow-up. Within 6 months postdischarge, patients with T2MI were significantly less likely to fill new prescriptions for P2Y12 inhibitors (4.8% [603/14,176] vs 52.8% [44,833/99,593], adjusted OR: 0.28; 95% CI: 0.25-0.31), beta blockers (27.1% [2,070/14,176] vs 62.8% [38,219/99,593], OR: 0.59; 95% CI: 0.55-0.63), statins (19.1% [1,439/14,176] vs 59.1% [32,434/99,593], OR: 0.51; 95% CI: 0.47-0.55), and SGLT2i or glucagon-like peptide-1 agonists (4.8% [595/14,176] vs 35.4% [30,202/99,593], OR: 0.30; 95% CI: 0.27-0.33) as compared to T1MI. Patients with T2MI were significantly less likely to undergo an echocardiogram (71.8% [10,179/14,176] vs 82.9% [82,551/99,593], OR: 0.61; 95% CI: 0.58-0.64) and coronary angiogram (11.7% [1,664/14,176] vs 76.6% [76,327/99,593], OR: 0.10; 95% CI: 0.09-0.11) compared to T1MI.
Conclusions:
In the United States, T2MI patients received less cardiovascular testing and secondary preventative therapies than T1MI patients.
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