Healthcare Utilization In Cardiomyopathy Patients Who Had Genetic Testing Before Or After Diagnosis

• Published in: Journal of cardiac failure 2023-04, Vol.29 (4), p.571-571
• Main Authors: Moretz, Chad, Smith, Elizabeth M, Aradhya, Swaroop, Callis, Tom, Esplin, Edward, Hatchell, Kathryn, Hall, Taryn, Nussbaum, Robert, Morales, Ana, Regalado, Ellen, Ren, Sheng, Rojahn, Susan, Vatta, Matteo, Murillo, Jaime
• Format: Article
• Language: English
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2022.10.065

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. 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. 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