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Background Hypertrophic cardiomyopathy (HCM) is the most common heritable cardiac disease. In small studies, sociodemographic factors have been associated with disparities in septal reduction therapy, but little is known about the association of sociodemographic factors with HCM treatments and outcomes more broadly. Methods and Results Using the National Inpatient Survey from 2012 to 2018, HCM diagnoses and procedures were identified by International Classification of Diseases, Ninth/Tenth Revision, Clinical Modification (ICD‐9‐CM and ICD‐10‐CM) codes. Logistic regression was used to determine the association of sociodemographic risk factors with HCM procedures and in‐hospital death, adjusting for clinical comorbidities and hospital characteristics. Of 53 117 patients hospitalized with HCM, 57.7% were women, 20.5% were Black individuals, 27.7% lived in the lowest zip income quartile, and 14.7% lived in rural areas. Among those with obstruction (45.2%), compared with White patients, Black patients were less likely to undergo septal myectomy (adjusted odds ratio [aOR], 0.52 [95% CI, 0.40–0.68]), or alcohol septal ablation (aOR, 0.60 [95% CI, 0.42–0.86]). Patients with Medicaid were less likely to undergo each procedure (aOR, 0.78 [95% CI, 0.61–0.99] for myectomy; aOR, 0.54 [95% CI, 0.36–0.83] for ablation). Women (aOR, 0.66 [95% CI, 0.58–0.74]), patients with Medicaid (aOR, 0.78 [95% CI, 0.65–0.93]), and patients from low‐income areas (aOR, 0.77 [95% CI, 0.65–0.93]) were less likely to receive implantable cardioverter‐defibrillators. Women (aOR, 1.23 [95% CI, 1.10–1.37]) and patients from towns (aOR, 1.16 [95% CI, 1.03–1.31]) or rural areas (aOR, 1.57 [95% CI, 1.30–1.89]) had higher odds of in‐hospital death. Conclusions Among 53 117 patients hospitalized with HCM, race, sex, social, and geographic risk factors were associated with disparities in HCM outcomes and treatment. Further research is required to identify and address the sources of these inequities.

Background Excess mortality from cardiovascular disease during the COVID‐19 pandemic has been reported. The mechanism is unclear but may include delay or deferral of care, or differential treatment during hospitalization because of strains on hospital capacity. Methods and Results We used emergency department and inpatient data from a 12‐hospital health system to examine changes in volume, patient age and comorbidities, treatment (right‐ and left‐heart catheterization), and outcomes for patients with acute myocardial infarction (AMI) and heart failure (HF) during the COVID‐19 pandemic compared with pre‐COVID‐19 (2018 and 2019), controlling for seasonal variation. We analyzed 27 427 emergency department visits or hospitalizations. Patient volume decreased during COVID‐19 for both HF and AMI, but age, race, sex, and medical comorbidities were similar before and during COVID‐19 for both groups. Acuity increased for AMI as measured by the proportion of patients with ST‐segment elevation. There were no differences in right‐heart catheterization for patients with HF or in left heart catheterization for patients with AMI. In‐hospital mortality increased for AMI during COVID‐19 (odds ratio [OR], 1.46; 95% CI, 1.21–1.76), particularly among the ST‐segment–elevation myocardial infarction subgroup (OR, 2.57; 95% CI, 2.24–2.96), but was unchanged for HF (OR, 1.02; 95% CI, 0.89–1.16). Conclusions Cardiovascular volume decreased during COVID‐19. Despite similar patient age and comorbidities and in‐hospital treatments during COVID‐19, mortality increased for patients with AMI but not patients with HF. Given that AMI is a time‐sensitive condition, delay or deferral of care rather than changes in hospital care delivery may have led to worse cardiovascular outcomes during COVID‐19.

Maternal mortality has been increasing in the United States over the past 3 decades, while decreasing in all other high‐income countries during the same period. Cardiovascular conditions account for over one fourth of maternal deaths, with two thirds of deaths occurring in the postpartum period. There are also significant healthcare disparities that have been identified in women experiencing maternal morbidity and mortality, with Black women at 3 to 4 times the risk of death as their White counterparts and women in rural areas at heightened risk for cardiovascular morbidity and maternal morbidity. However, many maternal deaths have been shown to be preventable, and improving access to care may be a key solution to addressing maternal cardiovascular mortality. Medicaid currently finances almost half of all births in the United States and is mandated to provide coverage for women with incomes up to 138% of the federal poverty level, for up to 60 days postpartum. In states that have not expanded coverage, new mothers become uninsured after 60 days. Medicaid expansion has been shown to reduce maternal mortality, particularly benefiting racial and ethnic minorities, likely through reduced insurance churn, improved postpartum access to care, and improved interpregnancy care. However, even among states with Medicaid expansion, significant care gaps exist. An additional proposed intervention to improve access to care in these high‐risk populations is extension of Medicaid coverage for 1 year after delivery, which would provide the most benefit to women in Medicaid nonexpanded states, but also improve care to women in Medicaid expanded states.