Discovered Inequalities in Implantable Heart Devices Among Various Races

Discovered Inequalities in Implantable Heart Devices Among Various Races

In a groundbreaking study published in Circulation, researchers from the University of Rochester Medical Center (URMC) have shed light on the disparities faced by Black patients with non-ischemic cardiomyopathy (NICM). The study, led by Dr. Arwa Younis, a former research fellow from URMC's Clinical Cardiovascular Research Center, found that Black patients with NICM have a higher burden of disease and a higher risk of death compared to their white counterparts.

The study examined the rate of events that a patient experiences after their Implantable Cardioverter-Defibrillator (ICD) is implanted for the prevention of sudden cardiac death. To their surprise, the researchers found that there is virtually no difference in results for Black and white patients with ischemic cardiomyopathy (ICM). However, in patients with NICM, stark differences were observed.

One of the key findings of the study is the disease severity and comorbidities faced by Black patients with NICM. These patients often present with more advanced heart failure and have a higher burden of comorbid conditions, such as diabetes and hypertension, which contribute to worse outcomes and increased mortality risk.

Another significant factor is the healthcare access and delivery. Systemic disparities, including disparities in access to specialty care, delays in diagnosis, and variations in treatment, can negatively impact outcomes in Black patients. The study highlights the need for more inclusive clinical trial designs and health equity initiatives to address these disparities.

The URMC Department of Medicine is taking steps to address these issues. They are implementing programs focused on diversity, equity, and inclusion (DEI), including standardized tools to analyze clinical outcomes by race and ethnicity. The goal is to identify and mitigate drivers of health disparities in conditions like NICM.

Dr. Ilan Goldenberg, the principal investigator of the study, suggests that primary prevention and treatment of comorbidities may help prevent the burden of cardiac disease in Black patients. He also agrees that Black patients who have heart failure are more likely to have more advanced arrhythmias and should be considered earlier for an ICD defibrillator to protect them from sudden cardiac death.

The study found that more than 85 percent of patients remained compliant at the one-year mark. However, Black patients were more likely to discontinue some medications, although this small numerical difference cannot explain the significant differences in outcomes.

The risk of death for Black patients, despite having an ICD to protect them, is two times higher. The study applied the Gini Index to its results, which revealed that Black patients tended to come from areas with lower socioeconomic status.

Dr. Goldenberg emphasizes the need for future studies to examine social determinants of health to understand why these findings occurred. He suggests that the younger age of onset and the increased rate of comorbidities among Black patients with NICM may contribute to worse outcomes.

Co-authors from the Cleveland Clinic, including Drs. Eileen Hsich and Oussama Wazni, also contributed to the study. The findings underscore the urgent need for healthcare providers and researchers to address the disparities faced by Black patients with NICM and work towards improving equitable care delivery.

1. This study,published in Circulation, focuses on disparities in non-ischemic cardiomyopathy (NICM) among Black patients.
2. The study was led by Dr. Arwa Younis, a former research fellow from URMC's Clinical Cardiovascular Research Center.
3. Black patients with NICM have a higher burden of disease and a higher risk of death compared to their white counterparts.
4. The study's results showed no significant difference between Black and white patients with ischemic cardiomyopathy (ICM).
5. In patients with NICM, however, stark differences were observed in disease severity and comorbidities.
6. Black patients with NICM often present with more advanced heart failure and a higher burden of comorbid conditions.
7. Systemic disparities in access to specialty care, delayed diagnosis, and variations in treatment affect Black patients' outcomes.
8. The URMC Department of Medicine is implementing programs focused on diversity, equity, and inclusion (DEI) to mitigate health disparities.
9. Standardized tools are being used to analyze clinical outcomes by race and ethnicity at URMC.
10. Primary prevention and treatment of comorbidities may help prevent the burden of cardiac disease in Black patients.
11. Black patients who have heart failure are more likely to have more advanced arrhythmias.
12. More than 85 percent of patients remained compliant at the one-year mark, but Black patients were more likely to discontinue some medications.
13. The risk of death for Black patients, despite having an ICD to protect them, is two times higher.
14. The Gini Index was applied to the study's results, revealing that Black patients come from areas with lower socioeconomic status.
15. Future studies should examine social determinants of health to understand these findings further.
16. The younger age of onset and the increased rate of comorbidities among Black patients with NICM may contribute to worse outcomes.
17. Co-authors from the Cleveland Clinic also contributed to the study, including Drs. Eileen Hsich and Oussama Wazni.
18. The findings underscore the urgent need for healthcare providers and researchers to address these disparities faced by Black patients with NICM.
19. It is crucial to work towards improving equitable care delivery for Black patients with NICM.
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