Discovered Inequalities in Implantable Heart Devices Among Racial Groups

Discovered Inequalities in Implantable Heart Devices Among Racial Groups

In a groundbreaking study published in Circulation, researchers have shed light on the higher burden of disease and increased mortality risk faced by Black patients with non-ischemic cardiomyopathy (NICM) who have implantable cardioverter defibrillators (ICDs).

The study, led by lead author Arwa Younis, MD, a former research fellow from the medical center's Clinical Cardiovascular Research Center, found that despite being on optimal medical therapy and having a high compliance rate, the burden of disease remained very high for Black patients with ICDs.

The risk of death for Black patients with ICDs is two times higher than that of white patients. One notable finding was the risk of ventricular arrhythmia, a sustained rapid heartbeat that can lead to sudden cardiac death, which was 31 percent for Black patients with ICDs, compared to 20 percent for white patients.

The study also suggests that the younger age of onset and the increased rate of comorbidities, such as diabetes and hypertension, among Black patients with NICM may contribute to worse outcomes.

Younis, now at the Cleveland Clinic and holding an adjunct position with the medical center, states that the findings indicate that Black patients with NICM face a constellation of social, economic, and systemic factors that increase their disease burden and mortality risk compared to white patients with the same condition.

Co-authors from the medical center include Sanah Ali, MD, Ido Goldenberg, MD, Scott McNitt, MS, Bronislava Polonsky, MS, Mehmet Aktas, MD, Valentina Kutyifa, MD, PhD, and Wojciech Zareba, MD, PhD. Co-authors from the Cleveland Clinic include Eileen Hsich, MD, and Oussama Wazni, MD, MBA.

Principal investigator Ilan Goldenberg, MD, hypothesizes that health care disparities may play a role, but did not identify any significant differences in the study. However, the Gini Index was applied to the study's results, indicating that Black patients tend to come from areas with lower socioeconomic status.

The study highlights areas where disparities remain, such as post-discharge management, including medication adherence, cardiac resynchronization therapy utilization, and timely follow-up care. Geographic and healthcare access disparities also influence outcomes, with some communities having less access to advanced cardiac services or facing differing ambulance and transfer protocols, which can affect survival.

Future studies should examine social determinants of health to understand why these findings occurred. Goldenberg agrees with Younis, suggesting that primary prevention and treatment of comorbidities such as diabetes and hypertension may help prevent the burden of cardiac disease in Black patients.

Addressing these multifactorial disparities requires interventions targeting not only hospital care but also broader community and socioeconomic inequities.

1. This study published in Circulation focuses on clinical trials related to non-ischemic cardiomyopathy (NICM) and implantable cardioverter defibrillators (ICDs).
2. The study, led by Arwa Younis, MD, uncovers the higher burden of disease and increased mortality risk among Black patients with ICDs.
3. Despite being on optimal medical therapy and having a high compliance rate, the burden of disease remains high for Black patients with ICDs.
4. The risk of death for Black patients with ICDs is two times higher than that of white patients.
5. The risk of ventricular arrhythmia, a sustained rapid heartbeat, is 31 percent for Black patients with ICDs compared to 20 percent for white patients.
6. One notable finding was the higher rate of comorbidities, such as diabetes and hypertension, among Black patients with NICM.
7. Younis, now at the Cleveland Clinic, suggests that social, economic, and systemic factors may contribute to worse outcomes for Black patients with ICDs.
8. The study included co-authors from the medical center and the Cleveland Clinic, including Eileen Hsich, MD, and Oussama Wazni, MD, MBA.
9. Principal investigator Ilan Goldenberg, MD, hypothesizes that healthcare disparities may play a role, but did not identify any significant differences in the study.
10. The Gini Index applied to the study's results indicated that Black patients tend to come from areas with lower socioeconomic status.
11. The study underscores the need for improved post-discharge management, including medication adherence, cardiac resynchronization therapy utilization, and timely follow-up care.
12. Geographic and healthcare access disparities also impact outcomes, affecting some communities' access to advanced cardiac services.
13. Future studies should explore social determinants of health to understand why these findings occurred.
14. Goldenberg agrees with Younis, suggesting that primary prevention and treatment of comorbidities such as diabetes and hypertension may help prevent the burden of cardiac disease in Black patients.
15. Addressing these multifactorial disparities necessitates interventions targeting not only hospital care but also broader community and socioeconomic inequities.
16. In light of this study, workplace-wellness programs might consider addressing these issues related to medical-conditions, chronic-diseases, and cardiovascular-health.
17. Environmental-science research could investigate the impact of climate-change on respiratory-conditions, digestive-health, and eye-health.
18. In line with mental-health awareness, men's-health initiatives should focus on the early detection and treatment of neurological-disorders.
19. Sexual-health discussions can play a role in family-health education, with a focus on reproductive health and safe practices.
20. Autoimmune-disorders research can contribute to the advancement of medical-science and therapies-and-treatments for various medical-conditions.
21. The manufacturing industry should consider implementing practices that prioritize environmental-sustainability and energy-efficient processes.
22. The mental-health industry could foster leadership and diversity-and-inclusion to create supportive workplaces that promote mental-wellness.
23. The aviation sector should prioritize safety procedures and training to mitigate risks associated with aircraft-operations and worker-health.
24. Investing in small-businesses and entrepreneurship can positively impact the housing-market, boosting affordable options for families.
25. The finance sector can contribute to wealth-management by offering financial-education resources to improve personal-finance literacy.
26. Banking-and-insurance professionals should consider offering programs that help individuals save, manage debt, and budget effectively.
27. The retail sector can collaborate with health-and-wellness organizations to promote nutrition, fitness-and-exercise, and wellness-products such as skin-care essentials.
28. Public-transit systems can focus on accessibility and affordability to improve transportation, which is crucial for people's health and familial responsibilities like parenting.
29. To ensure continuous innovation and advancement in clinical trials, the industry should foster collaborations and investments in fintech and venture-capital to further understand and tackle various health challenges, from cancer to skin-conditions and neurological-disorders.

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