The most concerning disparities in heart care outcomes: 2 cardiologists discuss

Eliminating disparities in heart care outcomes are a top priority for leading cardiology programs across the country. Research shows these disparities exist across racial, socioeconomic and gender lines, and the COVID-19 pandemic has only worsened these existing gaps.

At a Sept. 14 session at the Becker's Cardiology Virtual Forum, two leaders discussed disparities in heart care outcomes as well as steps their organizations are taking to address them. Panelists included:

• Armin Arbab-Zadeh, MD, PhD, director of cardiac computed tomography and associate professor of medicine at John Hopkins Medicine in Baltimore
• Manesh Patel, MD, professor of medicine and chief of the cardiology division and clinical pharmacology division at Durham, N.C.-based Duke Medicine

Here is an excerpt from the conversation, edited for clarity. To view the full session on-demand, click here.

Question: What is the one disparity in heart care outcomes that concerns you the most and why?

Dr. Manesh Patel: There's differential outcomes by both gender and race for cardiovascular conditions across the United States and in our area. And it concerns me because this disparity has worsened during COVID, where we've now seen both in our pandemic and others, that the vulnerable populations that live in our communities are getting less access to the cardiovascular care we need now. There's concern about getting access at our health systems, and so these differential outcomes continue.

Dr. Armin Zadeh: Among the many disturbing data in this regard, I was particularly struck with the large gap of age-adjusted mortality rates from hypertensive heart disease seen between African Americans and white patients. And specifically, there was a paper which particularly got my attention. It was published a few weeks ago in the British Medical Journal describing the burden of mortality to two subtypes of heart disease from 1998 to 2018 in more than 12 million U.S. individuals. These data were from the Wonder database.

They revealed a persistent and somewhat widening gap, with an approximately 36 percent mortality rate from hypertensive heart disease for Black men versus about 16 percent for white men. So more than double. And similarly, Black women had about double the mortality rate compared to white women from hypertensive heart disease. The reason why this is so striking to me is that hypertension is a relatively easily controllable disease where adverse events can be largely avoided with adequate treatment.

The data at the same time illustrates one of the major issues here, which is access to healthcare. Minorities have a larger proportion of uninsured individuals compared to white people and don't get regular care, and conditions like hypertension may be picked up late or don't get adequately treated.




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