Helping Doctors Advance Cardiovascular Health Equity

Originally published by TriplePundit

Research shows that women and people of color often suffer from advanced heart and vascular disease at disproportionately high rates. But their burden doesn’t end there. While these populations tend to be overrepresented in their disease rates, they also tend to be underrepresented in their treatment.

For example, take peripheral artery disease (PAD), a potentially serious vascular condition that reduces blood flow to the limbs, usually the legs. Black Americans have twice the rate of PAD than their white counterparts. Yet while PAD is a condition that can be managed if caught and treated early enough, Black patients also have dramatically worse outcomes, including being twice as likely to receive amputations due to severely blocked blood flow.

Treatment rates for other cardiovascular conditions show similar disparities, including:

• Coronary artery disease: Hispanic patients with heart attack symptoms are 15 percent less likely to receive percutaneous coronary intervention (PCI, also called angioplasty), a procedure to open blocked coronary arteries.
• Heart failure: Black and Hispanic patients are less likely to receive a pacemaker or implantable defibrillator to keep their hearts beating normally.
• Atrial fibrillation: Black patients are 50 percent less likely than white patients to receive a treatment called catheter ablation and represent only 4 percent of those who undergo an effective stroke-prevention treatment called left atrial appendage closure. Black AFib patients also have double the risk of stroke as white patients.
• Heart attack: Women wait 30 percent longer than men to receive cardiovascular care. Such delays are associated with worse outcomes: Women who have a heart attack are nearly twice as likely to die in the hospital than men.

That last statistic is especially personal for me. A few years ago, my mother, a Black retired nurse, developed terrible leg pain. Over three weeks she visited three different doctors, but none could provide a diagnosis or reduce her pain; even so, my mother’s reverence for physicians made her reluctant to seek yet another opinion. At last, however, she saw a fourth doctor, who realized my mother had had a heart attack and hurried her into treatment. Her just-in-time diagnosis allowed her to undergo life-saving procedures, for which I am thankful. She received the gift of two and a half extra years of life before her passing last November from her chronic coronary artery disease. But no one should struggle to get critical care the way my mother did.

Working with health systems to close the treatment gap

Today, health systems have begun recognizing the need to close treatment gaps and provide patients the equitable access they deserve. But creating change can be hard, especially with a problem so vast and deeply entrenched as health inequity. The difficulty in knowing where to start can be enough to paralyze even the most educated individuals and well-meaning organizations.

Fortunately, this is where equity-minded healthcare organizations have stepped up to help. Our 20-year-strong Close the Gap initiative at Boston Scientific, for example, supports healthcare systems in taking meaningful steps toward greater healthcare access for those who are typically underserved, including Black, Hispanic, and women patients living with cardiovascular disease. Through its targeted Heart and Vascular Health Equity Level-up Program, Close the Gap uncovers care disparities and collaborates with healthcare providers on strategies to better engage and treat these underrepresented groups, with an emphasis on improving the diverse patient experience through system change and building trust.

Close the Gap’s approach is also data-driven. Using national and local prevalence statistics for four common disease states (peripheral artery disease, coronary artery disease, atrial fibrillation, and heart failure), the team uses ZIP code-based data to identify which specific demographics are missing access to equitable care. Close the Gap then collaborates with providers and administrators to connect with those patient populations and improve the care experience based on health equity best practices.

Last year, for example, Close the Gap was approached by Piedmont Healthcare, a 22-hospital system that serves 3.4 million cardiology patients across Georgia. “We wanted to introspectively look at how we were faring in identifying individuals at high cardiovascular risk and providing care relative to their sex and ethnicity,” explains Dr. David Kandzari, chief of Piedmont Heart Institute. “For us, Close the Gap became the catalyst.”

Digging into the data, the Close the Gap and Piedmont teams looked at the treatment rates of a minimally invasive procedure used to treat coronary artery disease – the most common type of heart disease in the U.S. – and compared groups according to ethnicity and sex. While these procedures were broadly used across all patients, opportunities emerged to further explore differences. With those findings, the team came up with customized strategies for Piedmont, including plans for sharing information at a physician retreat, distributing patient educational materials in English and Spanish, and launching an educational web page on the Piedmont website.

Using that action plan, Piedmont has gotten off to a running start. “We’ve already raised awareness to more than 7,000 providers across the healthcare system,” says Dr. Kandzari, adding that Piedmont is also distributing patient materials through community programs, health fairs, and churches. “It’s been a rewarding experience for everyone here, and something we’re proud of,” he says. “And it’s motivated us to not stop there. This is really about a continuing initiative toward greater equity, so that all patients can receive the care they need.”

Equity progress over time, not overnight

When it comes to advancing health equity, we know that progress comes over time, not overnight. But those of us involved in this work can see how each small victory gets us a little closer to our goals. Each hospital willing to have those tough conversations, each doctor who takes a second look at a patient in light of a new awareness, each person who reads a flyer about cardiovascular health and decides to schedule a screening – every one of these is a step toward systemic change for the better.

The social return on this investment is worth it. Certainly, every life improved through more equitable treatment is well worth it. We’ll keep thoughtfully moving the work forward, celebrating every small victory along the way, until the day healthcare is finally fair and accessible to all.

This article series is sponsored by Boston Scientific.