There is an urgent need for biomedical and social interventions to address the significant racial and ethnicity-based disparities in clinical presentation, management, and outcome of hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM), respectively, according to two separate review articles authored by Ntobeko A.B. Ntusi, MBCHB, DPHIL, MD, and Karen Sliwa, MD, PhD, FACC, as part of Focused Seminar series on racism and health equity published in the Journal of the American College of Cardiology.

When it comes to HCM, Black patients are more likely to present with heart failure but are less commonly referred for symptom management, sudden cardiac death stratification, surgical septal myectomy, or for implantable cardioverter-defibrillators, all interventions that increase survival, note Ntusi and Sliwa. Additionally, Black patients with HCM have lower survival rates following hospital discharge for out-of-hospital cardiac arrest. Also of note, bystander-initiated CPR is less common when it comes to Black patients compared with White patients.

Racial segregation, lack of neighborhood walkability, racism or bias among health care works, lack of dedicated patient education and clinical programs, limited trust in health care works and poor linkages between health systems and communities are among the factors associated with these disparities in care related to HCM. Other social determinants of health like education, religious beliefs, economic status also have an impact.

Sliwa and Ntusi stress the need for targeted, multi-pronged and multi-sectoral interventions to help improve equity in care. In particular, they note the importance of enhanced patient education and greater understanding of the "drivers of race- and ethnicity-based disparities in [HCM] ... in terms of the impact on the individual, community, institution, and national realities." The also urge the use of implementation science to "support durable adoption of evidence-based interventions in Black patients and communities" that "go beyond enhancing linkages between health care systems and the communities and reduce the impact of social determinants of health on ethnicity-based disparities in [HCM] and other forms of cardiovascular disease."

Like HCM, DCM outcomes and survival rates are worse in Black patients compared with White patients. "DCM in Black patients is underrecognized and under-referred for effective therapies, a consequence of a complex interplay of social and socioeconomic factors," write Sliwa and Ntusi. The recommend the creation of multi-faceted strategies to manage social determinants of health and urge the exploration of policy changes to expand patient access to equitable care; provision of insurance, education, and housing. They also underscore the "urgent need to prioritize a social justice approach to health care and the pursuit of health equity to eliminate race and other disparities in the management of cardiovascular disease."

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, COVID-19 Hub, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Valvular Heart Disease, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Echocardiography/Ultrasound, Hypertension, Sleep Apnea

Keywords: Cardiology, Prejudice, Racism, Selection Bias, African Americans, Algorithms, Asian Americans, Atrial Fibrillation, Bariatric Surgery, Cardiomyopathy, Dilated, Benchmarking, Cardiomyopathy, Hypertrophic, Cardiopulmonary Resuscitation, Cardiovascular Diseases, Community Health Services, Coronary Artery Disease, COVID-19, Cultural Competency, Death, Sudden, Cardiac, Defibrillators, Implantable, Diabetes Mellitus, Type 2, Dementia, Echocardiography, Economic Status, Sexual and Gender Minorities, Ethnic Groups, Evidence-Based Medicine, Food Insecurity, Glycated Hemoglobin A, Health Care Costs, Health Equity, Health Personnel, Healthcare Disparities, Heart Disease Risk Factors, Heart Valve Diseases, Hospitals, Hispanic Americans, Heart Failure, Housing, Hypertension, Implementation Science, Insurance, Insurance Coverage, Minority Groups, Motivation, Morbidity, Obesity, Organizational Objectives, Outcome Assessment, Health Care, Out-of-Hospital Cardiac Arrest, Patient Discharge, Patient-Centered Care, Peripheral Arterial Disease, Prescriptions, Policy, Prevalence, Public Health, Quality Improvement, Reference Standards, Registries, Religion, Renal Insufficiency, Chronic, Reward, Risk Factors, Social Determinants of Health, Social Justice, Social Responsibility, Stroke, Survival Rate, Telemedicine, Telemedicine, Treatment Outcome, Trust, Violence, Violence, Workforce

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