Four new research papers highlight ways that health disparities appear commonly in cardiac care.
Here is what they found, according to a Nov. 11 report from Stat:
1. Preeclampsia and eclampsia occurs at 60% higher rates in Black women than white women. Preeclampsia is a leading cause of maternal mortality, leading to high risk of heart attack, stroke, heart failure and death, with more than half occurring within the first two weeks after delivery. Black women face higher odds for these complications. A study of nearly 30,000 insured patients found that serious cardiovascular events were more common in Black patients than white patients in the first year after delivery despite receiving this care. Pre-delivery cardiology care, something only 1 in 9 patients with preeclampsia receive, was linked to a 69% lower risk for white patients but not for Black patients.
2. Black veterans are less likely to be prescribed weight loss drugs. New obesity drugs can improve cardiovascular and metabolic health, though barriers to these medications — including high costs — can be considerable. Researchers looked at the VA system to identify if race or ethnicity altered who was prescribed semaglutide, sold as Ozempic for diabetes and Wegovy for obesity. Though obesity disproportionately affects people who are part of minority populations, Black veterans with obesity and Type 2 diabetes were less likely than white veterans with those conditions to receive semaglutide.
3. Social needs keep heart failure patients from quadruple therapy's benefits. Deaths from heart failure have been increasing since 2012. Only 1 in 5 patients with a type of heart failure classified as reduced ejection fraction receive all four forms of guideline-directed medical therapy. Quadruple therapy — which includes drugs known as renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium glucose cotransporter-2 inhibitors — reduce patient deaths by 73% over two years. To explain a low uptake of quadruple therapy, researchers looked at race and ethnicity, sex, and social determinants of health, social need and insurance status among nearly 83,000 people admitted to hospitals with heart failure as their primary diagnosis. They found Black and Hispanic individuals had better use of quadruple therapy for heart failure with reduced ejection fraction compared to white individuals, and females scored better than males. People were less likely to be on quadruple therapy if they had Medicaid, Medicare or no insurance compared to people with private insurance.
4. Cardiology fellows have mixed reviews on program DEI efforts. While affirmative action fades from college admission policies, efforts at the post-graduate level to elevate diversity, equity and inclusion may be facing future pushback. A sample of 101 cardiology fellows found that 67% believed that health equity was valued by their program, 65% viewed diversity and health equity as priorities of their programs, 30% did not feel supported by the culture of their institution, 49% believed that social determinants of health and health disparities were routinely discussed as part of their curriculum, and 43% thought the health disparities curriculum was sufficient. Overall, 58% said physicians in leadership positions who looked like them, but 92% of Black fellows disagreed.