P3164Relation of national economic status to diagnostic and management characteristics of patients with hypertrophic cardiomyopathy in the EORP cardiomyopathy registry of the european society of cardiology

Abstract

Background: The EORP Cardiomyopathy Registry is a prospective, observational, multinational registry of consecutive patients with cardiomyopathies. The aim of this substudy was to analyze the relation of national economic indicators to the diagnostic and therapeutic management of adult patients with HCM enrolled in the registry. Method(s): 1833 HCM patients were included in a pooled analysis of the pilot and long-term phases of the registry. National economic status was represented by gross domestic product (GDP). The 17 participating countries were distributed in 4 quartiles based in GDP (4th quartile corresponding to highest economic status). Data on general patient characteristics, diagnostic investigations and treatments were compared between GDP groups. Result(s): Compared to the highest quartile, patients in the lowest GDP quartile countries were older at diagnosis (48+15 vs 41+22, p 0.007), more frequently probands (92% vs 68%, p<0.001) and incident cases (89% vs 28%, p<0.001) and were more likely to have cardiovascular risk factors (p<0.01). More patients in lowest GDP countries were treated as inpatients in large centers, in contrast to high GDP countries where most enrolled patients were managed as outpatients in small centers (p<0.001). Patients from the highest GDP quartile countries had more non-obstructive (p<0.001) and apical forms (p 0.03) of HCM and tended to be more symptomatic (p<0.001). Exercise testing and cardiac MRI were performed in less than 10% of patients from the lowest GDP quartile countries. Genetic testing was reported more frequently in the highest economic level countries, but was <60% in all groups. The lowest numbers of implantable cardiac defibrillators were seen in countries from the lowest GDP quartile (4.3% vs 29.7% in the 4th quartile, p<0.001). Invasive treatment of left ventricular outflow tract obstruction was more frequent in higher GDP quartile countries (p<0.001). Conclusion(s): This study shows that the GDP of enrolling countries is associated with marked differences in the characteristics and treatment of patients with HCM enrolled in the EORP cardiomyopathy registry. These findings should be interpreted cautiously as they could reflect heterogeneity in enrolling networks and other factors unlikely to be captured by GDP alone. Nevertheless, they do form the basis of further study and have implications for the implementation of practice guidelines in different healthcare systems.