Sociodemographic Disparities in Outcomes, Costs, and Care in Obstructive Hypertrophic Cardiomyopathy

Obstructive hypertrophic cardiomyopathy (oHCM) is linked to serious cardiovascular events and substantial health care utilization, yet outcomes differ across patient groups.¹ An analysis of 14,744 US adults shows that female patients face higher stroke rates, Black patients have higher heart failure rates, and regional and age-related differences drive variation in health care resource use and costs, underscoring the impact of sociodemographic factors on disease burden.

This retrospective, noninterventional cohort study is published in the Journal of the American Heart Association.

“First, we found that Black patients had the highest rate of MACE [major adverse cardiovascular events] during variable follow‐up, whereas Asian patients had the lowest rate,” wrote the researchers of the study. “Next, female patients experienced higher rates of stroke, HF [heart failure], and all‐cause mortality than male patients over variable follow‐up. In addition, differences in rates of MACE across geographical regions were observed, with patients in the South and Midwest experiencing a higher rate of MACE than patients in the Northeast.”

oHCM is a form of cardiomyopathy in which the heart muscle becomes abnormally thickened, often without an obvious cause.² This thickening can obstruct blood flow out of the left ventricle, making it harder for the heart to pump blood effectively and potentially leading to symptoms such as shortness of breath, chest pain, lightheadedness, and fatigue. oHCM can affect people of all ages and may increase the risk of serious complications, including heart failure and arrhythmias.

The study utilized the Optum Market Clarity Integrated Clinical and Claims database to evaluate adults with oHCM in the US from 2013 to 2021.¹ Eligible patients had at least 2 medical claims with an oHCM diagnosis code. Follow-up periods varied depending on the outcome measure, including variable, fixed 1-year, and fixed 5-year windows. Outcomes assessed included rates of major adverse cardiovascular events, medication use, health care resource utilization (HCRU), and health care costs, stratified by age, sex, race, and geographic region to identify sociodemographic disparities.

The study included 14,744 adults with oHCM (mean [SD] age, 61.8 [14.0] years; 50.9% female). Female patients had higher rates of stroke compared with male patients (6863 vs 4773 per 100,000 patient-years), and Black patients experienced higher rates of heart failure than White patients (31,084 vs 20,603 per 100,000 patient-years).

Regional differences were observed, with patients in the South showing higher heart failure rates than those in the Northeast (25,406 vs 18,705 per 100,000 patient-years). Younger adults aged 18 to 39 years had more HCM-related ambulatory visits per month than older adults, and patients in the Midwest incurred the highest monthly HCM-related health care costs ($2071 vs $1440 in the Northeast), with all differences statistically significant (P < .001).

However, the researchers acknowledged the study had several limitations. This study relied on diagnosis codes, which may be subject to miscoding, and included only insured US adults of select racial and ethnic groups, limiting generalizability. Costs reflect payer charges, not patient payments, and missing data and unadjusted analyses are inherent to real-world studies. Newer therapies were not captured during the study period.

Despite the limitations, the researchers believe these findings highlight the impact of age, sex, race, and region on disease burden and suggest the need for tailored strategies to improve outcomes and equity in care.

“This study illustrates that among patients with oHCM, the rates of MACE, HCRU, and health care costs vary substantially between sociodemographic groups,” wrote the researchers. “Black patients incur greater inpatient and ED costs, and clinical and financial outcomes are significantly different across geographical regions and among patients receiving Medicaid and Medicare rather than commercial insurance.”

References

1. Reza N, Butzner M, Batra K, et al. Impact of sociodemographic characteristics on outcomes in obstructive hypertrophic cardiomyopathy. J Am Heart Assoc. 2026;27:e044294. doi:10.1161/JAHA.125.044294

2. Hypertrophic cardiomyopathy (HCM). American Heart Association. Accessed February 27, 2026. https://www.heart.org/en/health-topics/cardiomyopathy/what-is-cardiomyopathy-in-adults/hypertrophic-cardiomyopathy