Impact of Community Wealth on Use of Cardiac-Resynchronization Therapy With Defibrillators for Heart Failure Patients
Disparities in cardiovascular disease treatment are a major health policy concern. A complex interplay of patient, provider, and social contextual factors affect inequities in care. We used data regarding 22 205 patient stays in the National Cardiovascular Data Registry to explore the effect of hosp...
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| Veröffentlicht in: | Circulation Cardiovascular quality and outcomes 2012-11, Vol.5 (6), p.798-807 |
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| container_title | Circulation Cardiovascular quality and outcomes |
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| creator | FARMER, Steven A TUOHY, Elizabeth J SMALL, Dylan S YONGFEI WANG GROENEVELD, Peter W |
| description | Disparities in cardiovascular disease treatment are a major health policy concern. A complex interplay of patient, provider, and social contextual factors affect inequities in care.
We used data regarding 22 205 patient stays in the National Cardiovascular Data Registry to explore the effect of hospital resources on receipt of a heart failure therapy, cardiac-resynchronization therapy with defibrillation (CRT-D). When added to patient-level variables, hospital ownership, cardiac patient volume, cardiac procedure availability, CRT-D, implantable cardioverter-defibrillator implantation volumes, and hospital financial characteristics were individually predictive of CRT-D receipt. In the full hierarchical model, average median household income (P |
| doi_str_mv | 10.1161/CIRCOUTCOMES.112.965509 |
| format | Article |
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We used data regarding 22 205 patient stays in the National Cardiovascular Data Registry to explore the effect of hospital resources on receipt of a heart failure therapy, cardiac-resynchronization therapy with defibrillation (CRT-D). When added to patient-level variables, hospital ownership, cardiac patient volume, cardiac procedure availability, CRT-D, implantable cardioverter-defibrillator implantation volumes, and hospital financial characteristics were individually predictive of CRT-D receipt. In the full hierarchical model, average median household income (P<0.0001) and implantable cardioverter-defibrillator implantation volume (P<0.001) remained significant predictors of CRT-D receipt. Patients treated at hospitals in affluent communities were more likely to receive CRT-D than patients treated in poor communities, despite accounting for other patient and hospital characteristics, including insurance status.
These findings suggest that the likelihood of receiving CRT-D is mediated by community wealth and hospital resources, and that health policy targeting insurance coverage alone may be ineffective in resolving inequities in care.</description><identifier>ISSN: 1941-7713</identifier><identifier>EISSN: 1941-7705</identifier><identifier>DOI: 10.1161/CIRCOUTCOMES.112.965509</identifier><identifier>PMID: 23093561</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Biological and medical sciences ; Cardiac Resynchronization Therapy - economics ; Cardiac Resynchronization Therapy Devices - economics ; Cardiology. Vascular system ; Chi-Square Distribution ; Community Health Services - economics ; Defibrillators, Implantable - economics ; Economics, Hospital ; Electric Countershock - economics ; Electric Countershock - instrumentation ; Female ; Health Care Costs ; Health Services Accessibility - economics ; Healthcare Disparities - economics ; Heart ; Heart Failure - economics ; Heart Failure - therapy ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Humans ; Income ; Linear Models ; Logistic Models ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Registries ; Residence Characteristics ; Retrospective Studies ; Treatment Outcome ; United States</subject><ispartof>Circulation Cardiovascular quality and outcomes, 2012-11, Vol.5 (6), p.798-807</ispartof><rights>2014 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c392t-1d5ff945eb98989b1a50fdbedd1e7eb2c5fca3c6443ff9c33541ea060f06f5493</citedby><cites>FETCH-LOGICAL-c392t-1d5ff945eb98989b1a50fdbedd1e7eb2c5fca3c6443ff9c33541ea060f06f5493</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3673,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26752579$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23093561$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>FARMER, Steven A</creatorcontrib><creatorcontrib>TUOHY, Elizabeth J</creatorcontrib><creatorcontrib>SMALL, Dylan S</creatorcontrib><creatorcontrib>YONGFEI WANG</creatorcontrib><creatorcontrib>GROENEVELD, Peter W</creatorcontrib><title>Impact of Community Wealth on Use of Cardiac-Resynchronization Therapy With Defibrillators for Heart Failure Patients</title><title>Circulation Cardiovascular quality and outcomes</title><addtitle>Circ Cardiovasc Qual Outcomes</addtitle><description>Disparities in cardiovascular disease treatment are a major health policy concern. A complex interplay of patient, provider, and social contextual factors affect inequities in care.
We used data regarding 22 205 patient stays in the National Cardiovascular Data Registry to explore the effect of hospital resources on receipt of a heart failure therapy, cardiac-resynchronization therapy with defibrillation (CRT-D). When added to patient-level variables, hospital ownership, cardiac patient volume, cardiac procedure availability, CRT-D, implantable cardioverter-defibrillator implantation volumes, and hospital financial characteristics were individually predictive of CRT-D receipt. In the full hierarchical model, average median household income (P<0.0001) and implantable cardioverter-defibrillator implantation volume (P<0.001) remained significant predictors of CRT-D receipt. Patients treated at hospitals in affluent communities were more likely to receive CRT-D than patients treated in poor communities, despite accounting for other patient and hospital characteristics, including insurance status.
These findings suggest that the likelihood of receiving CRT-D is mediated by community wealth and hospital resources, and that health policy targeting insurance coverage alone may be ineffective in resolving inequities in care.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiac Resynchronization Therapy - economics</subject><subject>Cardiac Resynchronization Therapy Devices - economics</subject><subject>Cardiology. Vascular system</subject><subject>Chi-Square Distribution</subject><subject>Community Health Services - economics</subject><subject>Defibrillators, Implantable - economics</subject><subject>Economics, Hospital</subject><subject>Electric Countershock - economics</subject><subject>Electric Countershock - instrumentation</subject><subject>Female</subject><subject>Health Care Costs</subject><subject>Health Services Accessibility - economics</subject><subject>Healthcare Disparities - economics</subject><subject>Heart</subject><subject>Heart Failure - economics</subject><subject>Heart Failure - therapy</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Humans</subject><subject>Income</subject><subject>Linear Models</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Registries</subject><subject>Residence Characteristics</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><subject>United States</subject><issn>1941-7713</issn><issn>1941-7705</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkE1v3CAQhlHVqPlo_0LLpVIvTsAYvBwrN2lWSrVRsqserTEetFS22QI-bH59aHabVhxAw_PMjF5CPnF2ybniV83yoVlt1s3qx_VjrpSXWknJ9BtyxnXFi7pm8u3rm4tTch7jL8aUKJV4R05LwbSQip-ReTnuwCTqLW38OM6TS3v6E2FIW-onuon48gWhd2CKB4z7yWyDn9wTJJeB9RYD7LLisvANreuCGwZIPkRqfaC3CCHRG3DDHJDeZwmnFN-TEwtDxA_H-4Jsbq7XzW1xt_q-bL7eFUboMhW8l9bqSmKnF_l0HCSzfYd9z7HGrjTSGhBGVZXInBFCVhyBKWaZsrLS4oJ8OfTdBf97xpja0UWDecEJ_RxbzhdK80VOKKP1ATXBxxjQtrvgRgj7lrP2T-bt_5nnStkeMs_mx-OQuRuxf_X-hpyBz0cAooHBBpiMi_84VctS1lo8AzJ6jZE</recordid><startdate>20121101</startdate><enddate>20121101</enddate><creator>FARMER, Steven A</creator><creator>TUOHY, Elizabeth J</creator><creator>SMALL, Dylan S</creator><creator>YONGFEI WANG</creator><creator>GROENEVELD, Peter W</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20121101</creationdate><title>Impact of Community Wealth on Use of Cardiac-Resynchronization Therapy With Defibrillators for Heart Failure Patients</title><author>FARMER, Steven A ; TUOHY, Elizabeth J ; SMALL, Dylan S ; YONGFEI WANG ; GROENEVELD, Peter W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c392t-1d5ff945eb98989b1a50fdbedd1e7eb2c5fca3c6443ff9c33541ea060f06f5493</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiac Resynchronization Therapy - economics</topic><topic>Cardiac Resynchronization Therapy Devices - economics</topic><topic>Cardiology. Vascular system</topic><topic>Chi-Square Distribution</topic><topic>Community Health Services - economics</topic><topic>Defibrillators, Implantable - economics</topic><topic>Economics, Hospital</topic><topic>Electric Countershock - economics</topic><topic>Electric Countershock - instrumentation</topic><topic>Female</topic><topic>Health Care Costs</topic><topic>Health Services Accessibility - economics</topic><topic>Healthcare Disparities - economics</topic><topic>Heart</topic><topic>Heart Failure - economics</topic><topic>Heart Failure - therapy</topic><topic>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</topic><topic>Humans</topic><topic>Income</topic><topic>Linear Models</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Registries</topic><topic>Residence Characteristics</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>FARMER, Steven A</creatorcontrib><creatorcontrib>TUOHY, Elizabeth J</creatorcontrib><creatorcontrib>SMALL, Dylan S</creatorcontrib><creatorcontrib>YONGFEI WANG</creatorcontrib><creatorcontrib>GROENEVELD, Peter W</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation Cardiovascular quality and outcomes</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>FARMER, Steven A</au><au>TUOHY, Elizabeth J</au><au>SMALL, Dylan S</au><au>YONGFEI WANG</au><au>GROENEVELD, Peter W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Community Wealth on Use of Cardiac-Resynchronization Therapy With Defibrillators for Heart Failure Patients</atitle><jtitle>Circulation Cardiovascular quality and outcomes</jtitle><addtitle>Circ Cardiovasc Qual Outcomes</addtitle><date>2012-11-01</date><risdate>2012</risdate><volume>5</volume><issue>6</issue><spage>798</spage><epage>807</epage><pages>798-807</pages><issn>1941-7713</issn><eissn>1941-7705</eissn><abstract>Disparities in cardiovascular disease treatment are a major health policy concern. A complex interplay of patient, provider, and social contextual factors affect inequities in care.
We used data regarding 22 205 patient stays in the National Cardiovascular Data Registry to explore the effect of hospital resources on receipt of a heart failure therapy, cardiac-resynchronization therapy with defibrillation (CRT-D). When added to patient-level variables, hospital ownership, cardiac patient volume, cardiac procedure availability, CRT-D, implantable cardioverter-defibrillator implantation volumes, and hospital financial characteristics were individually predictive of CRT-D receipt. In the full hierarchical model, average median household income (P<0.0001) and implantable cardioverter-defibrillator implantation volume (P<0.001) remained significant predictors of CRT-D receipt. Patients treated at hospitals in affluent communities were more likely to receive CRT-D than patients treated in poor communities, despite accounting for other patient and hospital characteristics, including insurance status.
These findings suggest that the likelihood of receiving CRT-D is mediated by community wealth and hospital resources, and that health policy targeting insurance coverage alone may be ineffective in resolving inequities in care.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>23093561</pmid><doi>10.1161/CIRCOUTCOMES.112.965509</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Biological and medical sciences Cardiac Resynchronization Therapy - economics Cardiac Resynchronization Therapy Devices - economics Cardiology. Vascular system Chi-Square Distribution Community Health Services - economics Defibrillators, Implantable - economics Economics, Hospital Electric Countershock - economics Electric Countershock - instrumentation Female Health Care Costs Health Services Accessibility - economics Healthcare Disparities - economics Heart Heart Failure - economics Heart Failure - therapy Heart failure, cardiogenic pulmonary edema, cardiac enlargement Humans Income Linear Models Logistic Models Male Medical sciences Middle Aged Multivariate Analysis Odds Ratio Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Registries Residence Characteristics Retrospective Studies Treatment Outcome United States |
| title | Impact of Community Wealth on Use of Cardiac-Resynchronization Therapy With Defibrillators for Heart Failure Patients |
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