More work needs to be done to improve health equity when it comes to caring for patients with heart failure (HF), according to a paper published as part of a special nine-part Focused Seminar series on racism and health disparities published Dec. 6 in the Journal of the American College of Cardiology.

The paper, authored by Ileana L Piña, MD, MPH, FACC; Shirin Jimenez, MD, et al., explores the epidemiology, traditional cardiovascular risk factors and social determinants of health (i.e., income inequality, violence and mass incarceration in communities, and neighborhood environment and neighborhood segregation) unique to race-ethnic minorities and associated with inequities in HF treatment and outcomes. It also highlights the additional challenges posed by implicit bias and structural racism at patient, provider/health system and policy levels.

"[HF] is a syndrome that is indifferent to race, ethnicity, age and sex," write Piña and colleagues. "Although there are well known cardiovascular risk factors and abnormal physiology that may disproportionately affect racial and ethnic groups, there is never a justification for disparate care."

The authors provide several solutions designed to improve health equity and "to address systems of inequality that need to be recognized and dismantled/eradicated." Among the recommendations:

• Incorporating "practical strategies for mitigating disease in disadvantages communities," along with "metrics for optimal implementation of pharmacologic and device therapy," as part of clinical practice guidelines
• Advocating for policy changes at national and local levels that would mitigate health disparities, whether its addressing food insecurity or housing discrimination or increase patient access to important services
• Implementing implicit bias training for clinicians
• Increasing workforce diversity
• Leveraging pragmatic trial designs
• Using non-traditional health care settings like barbershops to reach diverse patient populations

Additionally, Piña and colleagues note a "common theme" running through the document is the importance of every clinician recognizing [cardiovascular] disparities within their own system of care. "Without these individual efforts, reaching equality of care for patients with HF, appears very distant," the write.

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

< Back to Listings