This cross-sectional study uses US insurance claims data to examine the rate of varenicline use for tobacco smoking cessation among adults with newly diagnosed peripheral artery disease.

BACKGROUND:Peripheral vascular intervention (PVI) is increasingly used for the treatment of peripheral arterial disease (PAD) with intermittent claudication (IC). However, large, real-world comparative studies of the safety and effectiveness of PVI compared with no PVI are limited. We sought to compare the effectiveness and costs of elective PVI compared with no PVI among patients with PAD and IC. METHODS:We conducted a 1:1 propensity-matched retrospective cohort analysis of commercially insured and Medicare Advantage patients in OptumLabs Data Warehouse from January 1, 2016, to September 30, 2023. Patients aged 18 years and older with incident diagnosis codes for PAD with IC were included. Patients undergoing elective PVI were matched to those who did not receive PVI based on demographics, calendar year, comorbidities, PAD-related medications, office visits, and baseline costs. The primary outcome was major adverse limb events (MALE), defined as a composite of new major amputation, new acute limb ischemia, and progression to chronic limb-threatening ischemia among patients with 12-months continuous enrollment. Secondary outcomes included subsequent PVI after a 30-day delay and costs of care. RESULTS:Among 26,716 propensity-matched patients, mean age was 70.5 years, and 41% of patients were women. Elective PVI was associated with a higher risk of MALE [incidence rate ratio (IRR), 2.20; 95% confidence interval (CI), 2.04-2.38], including new major amputations (IRR, 4.01; 95% CI, 2.45-6.55), new acute limb ischemia (IRR, 1.94; 95% CI, 1.73-2.18), and progression to chronic limb-threatening ischemia (IRR, 2.43; 95% CI, 2.22-2.67). Among the 13,358 patients who received elective PVI, 3477 patients (26.0%) received a repeat procedure during months 2 to 12 following the initial PVI. Elective PVI treatment was also associated with higher mean total cost of care, $44,934 compared with $26,452 among patients who did not receive PVI (cost ratio, 1.70; 95% CI, 1.65-1.75). CONCLUSIONS:In this large real-world study of patients with PAD and IC, elective PVI was associated with increased MALE compared with no PVI. These findings should inform a re-evaluation of the increasing use of PVI in this population.

Introduction: Peripheral vascular intervention (PVI) is increasingly used for the treatment of peripheral arterial disease (PAD) with intermittent claudication (IC). Large, real-world studies of PVI are needed. Research Question: What is the comparative effectiveness and costs of elective PVI compared to no PVI among patients with PAD and IC? Methods: We conducted a 1:1 propensity-matched retrospective cohort analysis of insured individuals ≥18 years with incident PAD diagnosis and IC without acute or chronic limb ischemia from 1/1/16-9/30/23 in OptumLabs ® Data Warehouse. Patients receiving elective PVI were matched to those who did not receive PVI based on 17 variables, including demographics, prior amputations, comorbidities, medications, and year. Patients with rest pain, ulcer, gangrene, and acute limb ischemia (ALI) were excluded. The primary outcome was major adverse limb events (MALE), a composite of new major amputations, conversion to chronic limb threatening ischemia (CLTI), and new ALI at 12 months. Secondary outcomes were probability of subsequent PVI after a 30-day delay and total costs of care. Results: Among 26,726 propensity-matched patients, mean age was 70.4 years, 41% were women. PVI was associated with a higher risk of MALE (hazard ratio [HR] 2.10, 95% CI 1.95-2.27), including major amputations, conversion to CLTI, and new ALI ( Table ). Among the 13,363 patients who received PVI, 3,479 (26.0%) received a repeat procedure within the next 12 months, compared to 61 (0.46%) who did not (HR 66.1, 95% CI 51.3-85.1). PVI was associated with higher mean costs of care over 12 months compared to no PVI ($44,951 [SD $44,342] vs $26,626 [SD $43,811]). Conclusion: In this large real-world study, elective PVI for PAD with IC was associated with increased major adverse limb events and subsequent PVIs along with an average $18,000 higher total cost of care at 12 months. These findings suggest that the role of PVI in treatment of IC should be re-assessed.

ObjectiveData from continuous glucose monitors (CGM) enable the extraction of features descriptive of glycemic dynamics that may provide insight into underlying health status. In this work, we analyse CGM data from a large population of individuals with type 2 diabetes (T2D) and study the association of features with clinical covariates.MethodsWe retrospectively analysed CGM and electronic health record data from a large population of individuals with T2D. We extracted 25 daily CGM features for each individual over a 30-day period and performed statistical association tests on the features and clinical findings from medical claims data and laboratory records.ResultsOur final analysis was performed on 6533 individuals. When clustering the CGM features across the population of individuals with T2D, four distinct clusters of features emerged. Further, the CGM features had heterogeneous discriminatory power with clinical covariates, including laboratory values and the presence of claims for diabetic complications. Features related to glycemic variability, such as coefficient of variation, showed markedly lower p-values in many association tests for the presence of diabetic complications than mean glucose.ConclusionsIn examining the characteristics of different features extracted from CGM data in a large population of individuals with T2D, we found that the features were heterogeneously associated with different clinical comorbidities related to diabetes. This work motivates further research to investigate the relationship between CGM features and health outcomes in T2D to enable precision medicine.

Objective Implantable loop recorders (ILRs) are increasingly used for long-term rhythm monitoring after ischaemic and cryptogenic stroke, with the goal of detecting atrial fibrillation (AF) and subsequent initiation of oral anticoagulation to reduce risk of adverse clinical outcomes. There is a need to determine the effectiveness of different rhythm monitoring strategies in this context.Methods We conducted a retrospective cohort analysis of individuals with commercial and Medicare Advantage insurance in Optum Labs Data Warehouse who had incident ischaemic or cryptogenic stroke and no prior cardiovascular implantable electronic device from 1 January 2016 to 30 June 2021. Patients were stratified by rhythm monitoring strategy: ILR, long-term continuous external cardiac monitor (>48 hours to 30 days) or Holter monitor (≤48 hours). The primary outcome was risk-adjusted all-cause mortality at 12 months. Secondary outcomes included new diagnosis of AF and oral anticoagulation, bleeding, and costs.Results Among 48 901 patients with ischaemic or cryptogenic stroke, 9235 received an ILR, 29 103 long-term continuous external monitor and 10 563 Holter monitor only. Mean age was 69.9 (SD 11.9) years and 53.5% were female. During the 12-month follow-up period, patients who received ILRs compared with those who received long-term continuous external monitors had a higher odds of new diagnosis of AF and oral anticoagulant initiation (adjusted OR 2.27, 95% CI 2.09 to 2.48). Compared with patients who received long-term continuous external monitors, those who received ILRs had similar 12-month mortality (HR 1.00; 95% CI 0.89 to 1.12), with approximately $13 000 higher costs at baseline (including monitor cost) and $2500 higher costs during 12-month follow-up.Conclusions In this large real-world study of patients with ischaemic or cryptogenic stroke, ILR placement resulted in more diagnosis of AF and initiation of oral anticoagulation, but no difference in mortality compared with long-term continuous external monitors.

Introduction: Disparities in access to care coupled with chronic conditions that represent 70% of healthcare spending, highlight the importance of accessible support beyond in-person primary care. In this study, we assessed the feasibility of a virtual peer mentoring program, in which individuals who have successfully managed to live with hypertension serve as peer mentors to individuals with the same condition. We measured clinical improvement through possible blood pressure (BP) reductions as well as program engagement and satisfaction among study participants. Methods: The study consisted of 451 participants enrolled in a Medicare Advantage plan with hypertension and/or a recent systolic BP reading ≥140 mmHg. Participants were matched with a peer mentor and provided with virtual one-on-one engagement based on their hypertension management challenges. The program was defined as feasible if the average monthly engagement rate over the 6-month study period was at least 70%. A one-sample proportion test was used to determine feasibility and the Wilcoxon signed rank test assessed changes in BP between the first month and the sixth month after enrollment. Descriptive statistics were generated from the exit survey upon program completion. Results: The average monthly engagement rate was greater than 70% (p < 0.001), indicating program feasibility. 116 individuals (25.7%) had a baseline systolic BP ≥ 140 mmHg, or diastolic BP ≥ 90 mmHg with both first and sixth month BP data. In this cohort, we found statistically significant median reductions in systolic BP >5 mmHg (-7.5 mmHg; p=0.003) as well as diastolic BP (-3.9 mmHg; p<0.001). The program received high satisfaction with a net promoter score of 79. Conclusion: This study showed a virtual peer mentoring program for individuals with hypertension is feasible. Both systolic and diastolic BP improved in the peer-matched group suggesting a beneficial intervention. In addition, the exit survey responses indicated satisfactory and positive experiences in this peer mentoring program.

Background:Obesity in pediatric patients is strongly associated with increased vascular and metabolic risk. Prediabetes is present in up to 1 in 5 adolescents, aged 12-18 years-old, though is thought to remit spontaneously in a significant portion. Pediatric patients with type 2 diabetes mellitus (T2D) have a more rapid decline of beta-cell function and progression to treatment failure than adult T2D patients. Thus, there is a strong interest in better understanding the natural history of prediabetes in these youth. We aimed to evaluate the real-world rate of progression of prediabetes to T2D in adolescent patients. Methods:This is a retrospective study of 9,275 adolescent subjects aged 12-21 years-old with at least 3 years of de-identified commercial claims data and a new diagnosis of prediabetes during the observation period. Enrollees with a T2D diagnosis and/or diabetes medication use in the 1 year prior to prediabetes diagnosis or a T2D diagnosis in the 1 month following prediabetes diagnosis were excluded. Enrollees with diagnoses of type 1 diabetes (T1D) or polycystic ovarian syndrome over the 3 years were also excluded. Progression to T2D was defined by claims data of two T2D diagnoses at least 7 days apart, HbA1c ≥ 6.5%, and/or prescription of insulin without known T1D. Enrollees were followed for 2 years after prediabetes diagnosis. Results:Overall, 232 subjects (2.5%) progressed from prediabetes to T2D. There were no differences found in T2D progression based on sex or age. Progression to T2D occurred at a median of 302 days after prediabetes diagnosis (IQR 123 to 518 days). This study was limited by the lack of laboratory/anthropometric data in administrative claims, as well as the exclusion of 23,825 enrollees for lack of continuous commercial claims data over 3 years. Conclusion:In the largest sample to date on adolescent prediabetes, we found a 2.5% progression of prediabetes to T2D over a median duration of about one year.

Importance:Spinal cord stimulators (SCSs) are increasingly used for the treatment of chronic pain. There is a need for studies with long-term follow-up. Objective:To determine the comparative effectiveness and costs of SCSs compared with conventional medical management (CMM) in a large cohort of patients with chronic pain. Design, Setting, and Participants:This was a 1:5 propensity-matched retrospective comparative effectiveness research analysis of insured individuals from April 1, 2016, to August 31, 2018. This study used administrative claims data, including longitudinal medical and pharmacy claims, from US commercial and Medicare Advantage enrollees 18 years or older in Optum Labs Data Warehouse. Patients with incident diagnosis codes for failed back surgery syndrome, complex regional pain syndrome, chronic pain syndrome, and other chronic postsurgical back and extremity pain were included in this study. Data were analyzed from February 1, 2021, to August 31, 2022. Exposures:SCSs or CMM. Main Outcomes and Measures:Surrogate measures for primary chronic pain treatment modalities, including pharmacologic and nonpharmacologic pain interventions (epidural and facet corticosteroid injections, radiofrequency ablation, and spine surgery), as well as total costs. Results:In the propensity-matched population of 7560 patients, mean (SD) age was 63.5 (12.5) years, 3080 (40.7%) were male, and 4480 (59.3%) were female. Among matched patients, during the first 12 months, patients treated with SCSs had higher odds of chronic opioid use (adjusted odds ratio [aOR], 1.14; 95% CI, 1.01-1.29) compared with patients treated with CMM but lower odds of epidural and facet corticosteroid injections (aOR, 0.44; 95% CI, 0.39-0.51), radiofrequency ablation (aOR, 0.57; 95% CI, 0.44-0.72), and spine surgery (aOR, 0.72; 95% CI, 0.61-0.85). During months 13 to 24, there was no significant difference in chronic opioid use (aOR, 1.06; 95% CI, 0.94-1.20), epidural and facet corticosteroid injections (aOR, 1.00; 95% CI, 0.87-1.14), radiofrequency ablation (aOR, 0.84; 95% CI, 0.66-1.09), or spine surgery (aOR, 0.91; 95% CI, 0.75-1.09) with SCS use compared with CMM. Overall, 226 of 1260 patients (17.9%) treated with SCS experienced SCS-related complications within 2 years, and 279 of 1260 patients (22.1%) had device revisions and/or removals, which were not always for complications. Total costs of care in the first year were $39 000 higher with SCS than CMM and similar between SCS and CMM in the second year. Conclusions and Relevance:In this large, real-world, comparative effectiveness research study comparing SCS and CMM for chronic pain, SCS placement was not associated with a reduction in opioid use or nonpharmacologic pain interventions at 2 years. SCS was associated with higher costs, and SCS-related complications were common.

Background: Implantable loop recorders (ILR) are increasingly used to screen for atrial fibrillation (AF) among patients with stroke, but real-world outcomes are lacking. Goal: To determine comparative effectiveness, safety, and costs of ILR compared with continuous external monitors (CEM) and Holter monitors in a real-world setting of patients with stroke. Methods: This retrospective cohort analysis used the Optum Labs Data Warehouse, which contains longitudinal, de-identified administrative claims. The cohort included patients with recent stroke who received cardiac monitoring from 1/1/2016 - 6/30/2021, comparing those with ILR to those with CEM (>48 hours to 30 days) or Holter (≤48 hours). Eligibility criteria included: ischemic stroke during 6 month baseline; continuous enrollment with medical and pharmacy coverage; no evidence of pacemaker, implantable cardioverter-defibrillator, AF, left atrial appendage ablation, or oral anticoagulants. The primary outcome was 12-month all-cause mortality, secondary outcomes included new diagnosis of AF + initiation of anticoagulants, hemorrhagic stroke, and total and device-related costs. Final analyses were adjusted for CHA 2 DS 2 -VASc score. Results: Among 48,801 individuals, 18.9% received ILR, 59.5% CEM, and 21.6% Holter. Groups had similar demographics and comorbidities (Table). Compared to those with CEM, the ILR group had higher odds of a new diagnosis of AF plus initiation of anticoagulants (OR 2.27; (95% CI 2.09, 2.48)), and hemorrhagic stroke (OR of 1.60 (95% CI 1.34, 1.93)). There was no difference in mortality. Unadjusted direct medical cost of monitoring was substantially higher in the ILR group ($13,975) compared to CEM ($449) and Holter ($149). Conclusions: Although the use of ILRs was associated with increased detection and treatment for AF, there was no impact on all-cause mortality. ILR was associated with increased hemorrhagic stroke and higher costs.

HomeCirculation: Genomic and Precision MedicineAhead of PrintReal-World Genetic Testing Utilization Among Patients With Cardiomyopathy No AccessResearch ArticleRequest AccessAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessResearch ArticleRequest AccessReal-World Genetic Testing Utilization Among Patients With Cardiomyopathy Ana Morales, Chad Moretz, Sheng Ren, Elizabeth Smith, Thomas E. Callis, Taryn Hall, Kathryn E. Hatchell, Robert L. Nussbaum, Ellen Regalado, Susan Rojahn, Matteo Vatta, Edward D. Esplin and Jaime Murillo Ana MoralesAna Morales https://orcid.org/0000-0002-5882-1341 Invitae Corporation, San Francisco, CA (A.M., C.M., T.E.C., K.E.H., R.L.N., E.R., S. Rojahn, M.V., E.D.E.). , Chad MoretzChad Moretz https://orcid.org/0000-0003-2255-4330 Invitae Corporation, San Francisco, CA (A.M., C.M., T.E.C., K.E.H., R.L.N., E.R., S. Rojahn, M.V., E.D.E.). , Sheng RenSheng Ren Optum Labs, Eden Prairie, MN (S. Ren, E.S., T.H., J.M.). , Elizabeth SmithElizabeth Smith https://orcid.org/0000-0002-0239-5021 Optum Labs, Eden Prairie, MN (S. Ren, E.S., T.H., J.M.). , Thomas E. CallisThomas E. Callis https://orcid.org/0000-0001-7670-5443 Invitae Corporation, San Francisco, CA (A.M., C.M., T.E.C., K.E.H., R.L.N., E.R., S. Rojahn, M.V., E.D.E.). , Taryn HallTaryn Hall https://orcid.org/0000-0001-6018-8613 Optum Labs, Eden Prairie, MN (S. Ren, E.S., T.H., J.M.). , Kathryn E. HatchellKathryn E. Hatchell https://orcid.org/0000-0003-0849-7018 Invitae Corporation, San Francisco, CA (A.M., C.M., T.E.C., K.E.H., R.L.N., E.R., S. Rojahn, M.V., E.D.E.). , Robert L. NussbaumRobert L. Nussbaum https://orcid.org/0000-0003-3445-8880 Invitae Corporation, San Francisco, CA (A.M., C.M., T.E.C., K.E.H., R.L.N., E.R., S. Rojahn, M.V., E.D.E.). , Ellen RegaladoEllen Regalado https://orcid.org/0000-0002-5859-218X Invitae Corporation, San Francisco, CA (A.M., C.M., T.E.C., K.E.H., R.L.N., E.R., S. Rojahn, M.V., E.D.E.). , Susan RojahnSusan Rojahn https://orcid.org/0000-0001-5888-7693 Invitae Corporation, San Francisco, CA (A.M., C.M., T.E.C., K.E.H., R.L.N., E.R., S. Rojahn, M.V., E.D.E.). , Matteo VattaMatteo Vatta https://orcid.org/0000-0002-1742-7719 Invitae Corporation, San Francisco, CA (A.M., C.M., T.E.C., K.E.H., R.L.N., E.R., S. Rojahn, M.V., E.D.E.). , Edward D. EsplinEdward D. Esplin https://orcid.org/0000-0001-9205-3756 Invitae Corporation, San Francisco, CA (A.M., C.M., T.E.C., K.E.H., R.L.N., E.R., S. Rojahn, M.V., E.D.E.). and Jaime MurilloJaime Murillo Correspondence to: Jaime Murillo, MD, Optum Labs, 11000 Optum Cir, Eden Prairie, MN 55344. Email E-mail Address: [email protected] https://orcid.org/0000-0003-2439-8685 Optum Labs, Eden Prairie, MN (S. Ren, E.S., T.H., J.M.). Originally published13 Dec 2023https://doi.org/10.1161/CIRCGEN.122.004028Circulation: Genomic and Precision Medicine. 2023;0:e004028FootnotesFor Sources of Funding and Disclosures, see page xxx.Correspondence to: Jaime Murillo, MD, Optum Labs, 11000 Optum Cir, Eden Prairie, MN 55344. Email jaime_murillo@uhg.com eLetters(0) eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate. Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page. Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article Information Metrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/CIRCGEN.122.004028PMID: 38088168 Originally publishedDecember 13, 2023 Keywordsadultcardiomyopathiesgenetic testinghumansmolecular diagnosisPDF download Advertisement Subjects Genetic, Association Studies

Heart failure (HF) is a complex syndrome traditionally classified by left ventricular ejection fraction (LVEF) cutpoints. Although LVEF is prognostic for risk of events and predictive of response to some HF therapies, LVEF is a continuous variable and cutpoints are arbitrary, often based on historical clinical trial enrichment decisions rather than physiology. Holistic evaluation of the treatment effects for therapies throughout the LVEF range suggests the standard categorization paradigm for HF merits modification. The multidisciplinary Heart Failure Collaboratory reviewed data from large-scale HF clinical trials and found that many HF therapies have demonstrated therapeutic benefit across a large range of LVEF, but specific treatment effects vary across that range. Therefore, HF should practically be classified by association with an LVEF that is reduced or not reduced, while acknowledging uncertainty around the precise LVEF cutpoint, and future research should evaluate new therapies across the continuum of LVEF.

Introduction Major professional societies recommend genetic testing for patients with suspected or diagnosed cardiomyopathy (CM), but the impact of genetic testing on healthcare utilization is unclear. We compared healthcare utilization for CM patients receiving genetic testing (GT) as part of their diagnostic workup vs. after their clinical diagnosis. Methods We conducted a retrospective analysis of commercial and Medicare claims data using the Optum Labs research database. Selected patients were ≥18 years of age with ≥2 ICD-10 CM diagnosis codes [I42.0 (dilated CM, DCM), I42.1 (obstructive CM), I42.2 (hypertrophic CM, HCM), I42.5 (restrictive CM, RCM), I42.8 (arrhythmogenic right ventricular CM, ARVC), O90.3 (peripartum cardiomyopathy, PPCM)] from 01/01/2017 to 10/01/2020, and continuous enrollment 12 months pre and post first CM claim date (diagnosis index date). Exclusions included a personal and/or family history of cancer and >1 genetic test claim. Procedure codes from 01/01/2016 to 10/01/2021 were reviewed for GT claims. Patients with a GT claim on or after CM diagnosis formed the GT confirmation cohort (GTCC). Patients with a GT claim prior to CM diagnosis formed the GT diagnostic work-up cohort (GTDWC). A control cohort of CM patients without a GT claim were matched to the GTCC and GTDWC cohorts by propensity score matching (1:1 nearest-neighbor matching with a 0.2 caliper). The Charlson Comorbidity Index (CCI) was used as an overall measure of comorbidities. Binary utilization outcomes were compared with chi-square and Fisher exact tests; utilization counts were compared with a Mann-Whitney U test. Results Of 75,400 patients with a CM diagnosis, only 1,770 (2.3%) had a GT. The GTCC cohort and its matched control each had 827 patients (mean age 62 years); 20% of the matched cohorts had CCI 5+. The GTDWC cohort and its matched control each had 462 patients (mean age 64 years); 29% of the matched cohorts had CCI 5+. In the GTCC, the distribution of CM diagnoses was 45% ARVC, 23% DCM or PPCM, 30% HCM or HCM/ARVC, and 2% RCM. In the GTDWC cohort, the distribution was 50% ARVC, 31% DCM or PPCM, 17% HCM or HCM/ARVC, and 2% RCM. GTCC hospitalizations and emergency (ER) visits after CM diagnosis were each approximately 5% higher than in controls, but the difference was non-statistically significant at the p<0.05 level. Utilization was similar between GTDWC patients and controls. Conclusion Genetic testing is underutilized in CM patients. This data shows that the utilization of hospitalizations or ER visits is similar in CM patients regardless of when GT was used. Additional research is warranted to examine the most appropriate time for CM GT.

Background: Metformin is not FDA-approved for prediabetes but it is being prescribed off-label for this condition. Per the American Diabetes Association (ADA), metformin “should be considered” for ...

Background: Racial disparities in the management and outcomes of myocardial infarction have been widely reported. Overall, the rate of cardiovascular (CV) death has risen since 2010 while hospitalization rates remain flat. Here, we provide a comprehensive analysis, using a large database, of the evolving profile of Black Americans (BA) who suffered myocardial infarctions (MI) over the past 10 years and compared BA to the non-Black (non-BA) population. We also describe the change in their characteristics between 2 continuous 5-year periods (2010-14, 2015- 19) with the goal of identifying opportunities for care improvement. Methods: We used the OptumLabs Data Warehouse EHR data. Acute MI cases were based on discharge diagnosis codes for adults > 35 years of age between 1/1/2010 and 12/31/2019. A single individual could have had multiple MI’s. Data were analyzed descriptively. Results: A total of 36M annual observations were analyzed which included 129,146 MI’s with complete EHR data. MI’s among BA patients comprised 8.7% of the total in the 1 st period and went up to 10.4% in the 2 nd period.The main characteristics between BA and non-BA cases and between periods are shown in the table. In general, BA MI patients were younger than non-BA (57% vs 40% were <65). Conclusion: Compared to non-Blacks, Black patients with myocardial infarctions over the past 10 years exhibit a profile characterized by: MI’s at a younger age, almost half female, more DM, higher cholesterol and blood pressure levels, higher rate of smoking, more are Medicaid and ¾ live in the South.When comparing only Black patients between 2010-14 and 2015-2019 there was a marked increase in total MI’s, mostly in the 55-75 age range, increased diabetes, smoking and rising SBP levels.The description of an evolving profile among Blacks with MI’s could, at least partly, explain the rising trend of CV mortality, identify potential gaps in care and the need to design new forms to detect subclinical atherosclerosis.

Introduction: Professional guidelines support genetic testing (GT) for dilated, hypertrophic, restrictive, arrhythmogenic, and peripartum cardiomyopathy to confirm a diagnosis, guide management, enable clinical trials, and/or allow more informed genetic counseling. Analysis of de-identified data from a commercial laboratory showed that 1 in 4 individuals who had cardiomyopathy GT billed to a national health insurer had a positive result; however, which patients undergo GT is largely unknown. Hypothesis: GT is underutilized in patients with genetic cardiomyopathy. Methods: A retrospective analysis was conducted using commercial and Medicare claims data from the UnitedHealth Group Clinical Discovery Database. The GT-cohort (index: GT dates 1/1/2017-12/31/2020) included patients with 12-months pre-index data including ≥1 ICD-10 codes associated with genetic or unspecified cardiomyopathy and GT Current Procedural Terminology (CPT) code(s). The non-GT cohort (index: outpatient visit dates 1/1/2017-12/31/2020 with 12-month pre-index data) had the same ICD codes, but no GT CPT code. Individuals with a personal and/or family history of cancer were excluded to avoid patients who had GT for cancer. Multivariable logistic regression analysis was performed to examine factors associated with GT. Results: Of 300,127 patients with cardiomyopathy, 3,287 (1.1%) had a GT CPT code. Factors that predicted a higher likelihood of GT (p < 0.05) included being younger, living in an area with a higher education level, commercial insurance, no diagnosis of diabetes or myocardial infarction, diagnosis of mild liver disease, a higher number of outpatient medical and cardiology visits, cardiac-related hospitalizations (shorter length-of-stay), a higher number of 30-day all-cause readmissions, a higher number of cardiomyopathy diagnoses, and except for peripartum, all genetic cardiomyopathy types. Conclusions: Only 1.1% of patients with a cardiomyopathy ICD code had a GT claim. Considering a potential 25% testing yield, a larger portion could have benefited from a genetics guided diagnosis. More research is needed to investigate barriers related to GT and improve our ability to identify those who could benefit from cardiomyopathy genetic testing.

Introduction: The management of type 2 diabetes mellitus (DM) has focused on achieving normal glucose levels in order to prevent cardiovascular disease (CVD) and other DM-related complications. Some have suggested that glucose variability (GV) may be associated with DM complications. Other studies, using manual glucose testing, failed to prove it. In our retrospective study using a large administrative database and thousands of patients wearing continuous glucose monitors (CGM), we evaluated the association between various glucose parameters and CVD and DM complications. Methods: Of 15,815 people enrolled in a T2DM program who ordered a CGM device, 58.2% actually used it. The final cohort had 4,530 CGM users with > 30 days of CGM data within 90 days. Metrics included mean glucose and GV measures such as SD, IQ range, % coefficient of variation (%CV), mean amplitude of glycemic excursions (MAGE) and time in range. A multivariable regression analysis tested for the association between these metrics and the occurrence of CVD and DM complications based on claims from Jan 2016 through April 2021. Results: The mean age was 53, with a 1:1 gender ratio. Mean glucose level was 157 (SD + 32). At least one CVD condition or DM complication (nephro-, retino-, neuropathy, skin ulcer/gangrene, circulatory problems) was present in 84% of subjects. The 2 most frequent were ischemic heart disease (IHD) in 15.7% and DM kidney disease in 9.5%. Subjects with IHD or DM complications had significantly higher mean glucose and GV measures (p<0.001). However, there was a 10-fold difference between a marker of variability (%CV) and the mean glucose level: for every % point increase in %CV there was a 7% increased likelihood of DM complications, compared with only a 0.7% increase for every additional 1 mg/dl of mean glucose. Conclusions: In a relatively young cohort of persons with T2DM wearing CGM, glycemic variability, as measured by %CV, was more strongly associated with IHD and diabetic complications than mean glucose level. This suggests that management of diabetes should focus more on glycemic variability than absolute glucose levels. Wider adoption of CGM may more effectively detect persons with high glycemic variability at risk for ischemic heart disease and other diabetic complications.