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Background: Digital health technology is becoming central to health care. A better understanding of the trends and predictors of its use could reflect how people engage with the health care system and manage their health care needs.Methods: Using data from the National Health Interview Survey for years 2011 to 2018, we assessed the use of digital health technology among individuals aged ≥18 years in the United States across 2 domains: 1) search for health information online and 2) interaction with health care providers (eg, fill a prescription, schedule a medical appointment, or communicate with health care providers).Results: Our study included 253,829 individuals; representing nearly 237 million adults in the United States annually; mean age 49.6 years (SD 18.4); 51.8% women; and 65.9% non-Hispanic white individuals. Overall, 49.2% of individuals reported searching for health information online and 18.5% reported at least 1 technology-based interaction with the health care system. Between 2011 and 2018, the proportion who searched for health information online increased from 46.5% to 55.3% (P < .001), whereas the proportion who used technology to interact with the health care system increased from 12.5% to 27.4% (P < .001). Although technology-based interaction with the health care system increased across most subgroups, there were significant disparities in the extent of increase across clinical and sociodemographic subgroups.Conclusions: The use of digital health technologies increased between 2011 and 2018, however, the uptake of these technologies has been unequal across subgroups. Future innovations and strategies should focus on expanding the reach of digital heath technology across all subgroups of society to ensure that its expansion does not exacerbate the existing health inequalities. [ABSTRACT FROM AUTHOR]

Background: Blood pressure is a physiologic measure that reflects cardiac output and systemic vascular resistance. Classification by these components could be useful in characterizing subtypes of hypertension, which may have a role in selecting treatment strategies. However, hemodynamic phenotypes of a large, stable, outpatient population with hypertension remain unknown.Methods: We included 34,238 people with systolic blood pressure of ≥130 mm Hg, who underwent impedance cardiography at 51 sites of iKang Health Checkup Centers throughout China between 2012 and 2018. Hemodynamic parameters measured included stroke volume, stroke volume index, heart rate, cardiac output, cardiac index, systemic vascular resistance, and systemic vascular resistance index. We characterized these by systolic blood pressure categories and assessed patient characteristics associated with the ratio of cardiac index to systemic vascular resistance index.Results: Among the study cohort (n = 33,414; mean age 52 ± 13 years; 36.6% female), 49%, 40%, and 11% had systolic blood pressure130-139, 140-159, and ≥160 mm Hg, respectively. Among patients with systolic blood pressure 140-159 mm Hg, 9353 (70%) had high systemic vascular resistance index but normal/low cardiac index, 1949 (15%) had high cardiac index but low/normal systemic vascular resistance index, and 2053 (15%) had low/normal cardiac index and systemic vascular resistance index. Using multivariable analysis, we found that cardiac index to systemic vascular resistance index ratio was negatively associated with age and body mass index (all P <0.05; R-square 0.16, 0.12, and 0.09 for systolic blood pressure 130-139, 140-159 and ≥160 mm Hg, respectively).Conclusions: Different hemodynamic blood pressure phenotypes were identified across all hypertensive blood pressure categories. Although individual characteristics were associated with the cardiac index to systemic vascular resistance index ratio, they only weakly explained the variation. [ABSTRACT FROM AUTHOR]

Background: Little is known about national patterns of anticoagulant use among patients with atrial fibrillation after the availability of direct oral anticoagulants (DOACs) and the associated implications for healthcare spending.Methods: The Medical Expenditure Panel Survey, a nationally representative survey, collects detailed information about prescription drug use, cost, and medical diagnoses. Using International Classification of Disease Ninth Edition (ICD-9) codes and self-reporting, adults with atrial fibrillation were estimated between 2010 and 2014. We examined proportions of patients receiving warfarin and DOACs overall and across sociodemographic and clinical groups. Total drug expenditures and out-of-pocket spending were calculated adjusting to 2014 US dollars.Results: The study population ranged from 364 (equivalent to 4.7 million) in 2010 to 409 (equivalent to 5.5 million) in 2014. Overall use of any anticoagulant increased from 32.4% to 40.1%. DOAC use increased from 0.56% to 17.2%, and warfarin use declined from 32.8% to 22.9% (p trend < 0.01). This trend was seen in nearly all subgroups evaluated. Estimated prescription drug spending on DOACs and warfarin during this time rose from $330 million to $1.9 billion. Out-of-pocket costs for DOACs increased from $10 million to $218 million.Conclusion: In a large, nationwide cohort of adults with atrial fibrillation, we observed a rapid increase in the use of DOACs, significant disparities in medication use based on sociodemographic and clinical factors, and an increase in overall and out-of-pocket costs for anticoagulants corresponding to the increased use of DOACs. These patterns have important implications for healthcare quality, equity, and spending. [ABSTRACT FROM AUTHOR]