This post was authored by William J Oetgen, MD, MBA, FACC, ACC's senior vice president of Science and Quality.

A recent study using data from the NCDR’s® ICD Registry™ found that the likelihood of receiving cardiac-resynchronization therapy with defibrillation (CRT-D) is mediated by community wealth and hospital resources. The study looked at 22,205 patient stays and found in the full hierarchical model, average median household income (P<0.001) and implantable cardioverter-defibrillator implantable volume (P<0.001) remained significant predictors of CRT-D receipt. Further, patients treated at hospitals in affluent communities were more likely to receive CRT-D than patients treated in poor communities, despite accounting for other patient and hospital characteristics, including insurance status.

Since health care disparities are complex issues, and it has been shown that “variations by race and ethnicity exist in the use of medical devices for the treatment of advanced heart failure,” the study attempted to address the “relative impact of patient-, hospital-, and community-level factors on the likelihood of CRT-D receipt.”

The lead author noted that the analysis demonstrates that the wealth of the community in which patients live impacts the care they receive, and the relationship between median household income and receipt of CRT-D persisted regardless of the patient’s insurance status. The authors also note that their findings have important implications for efforts to address healthcare disparities and that health policy targeting insurance coverage alone will be ineffective in resolving inequities in care.

The ACC has been working on several initiatives to address gaps in care like the example above. ACC’s credo initiative seeks to help clinicians better serve all of their patients, regardless of race, ethnicity, gender, primary language, or other factors that may impact care. The ACC has also been working with groups like the National Minority Quality Forum on the CardioMetabolic Health Alliance, to improve cardiometabolic risk factor control in diverse populations.

In addition, this past year the ACC and its CardioSmart initiative has partnered with the Association of Black Cardiologists on a series of community events aimed at increasing awareness of heart disease and promoting better heart health, particularly in high-risk communities. The next event, called Spirit of the Heart, will take place this weekend in Harlem, NY (read more about Spirit of the Heart and view photos from the event in a previous blog post here).

We know the complex problems related to health care disparities cannot be solved overnight, but it is our hope that these initiatives will slowly but surely help close the gaps in care.

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