Identified Inequalities in Implantable Heart Device Patients Based on Race

Identified Inequalities in Implantable Heart Device Patients Based on Race

In a groundbreaking study published in Circulation, researchers have uncovered stark differences between Black and white patients with non-ischemic cardiomyopathy (NICM). The study, led by Principal Investigator Ilan Goldenberg, MD, from the medical center, and co-authors including Arwa Younis, MD (now at the Cleveland Clinic) and Eileen Hsich, MD from the Cleveland Clinic, sheds light on the higher burden and mortality risk experienced by Black patients with NICM.

Dr. Younis, a former research fellow from the medical center's Clinical Cardiovascular Research Center, was surprised by the extent of the study's results. The researchers found that Black patients with NICM had a higher age of onset and a greater rate of comorbidities, such as diabetes and hypertension, which may contribute to the worse outcomes due to more advanced heart disease.

The study found that the risk of death for Black patients, despite having an implantable cardioverter-defibrillator (ICD) to protect them from sudden cardiac death, was two times higher than that of white patients. This disparity, according to Dr. Goldenberg, is due to a combination of factors including higher rates of hypertension and hypertensive heart disease, social determinants of health, unequal access to care, and possibly higher rates of stimulant or substance use contributing to worse heart failure outcomes.

Dr. Goldenberg 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. However, the study found virtually no difference in results for Black and white patients with ischemic cardiomyopathy (ICM) because the scar is essentially the same in both races.

Future studies should examine social determinants of health to understand why these findings occurred, according to Dr. Goldenberg. Efforts to reduce these disparities should focus on improving blood pressure control, equitable healthcare delivery, patient education, and addressing broader social determinants of health.

Dr. Younis suggests that Black patients with an ICD should receive aggressive positive treatment as early as possible, including close monitoring, specialist referrals, and earlier device implantation. After one year, Black patients were more likely to discontinue some medications, but this small difference cannot explain the significant differences in outcomes.

The study applied the Gini Index, which compares zip codes across the country to indicate that Black patients tend to come from areas with lower socioeconomic status. The researchers believe that health care disparities might be a factor, but the study did not identify any significant differences in care.

In conclusion, the higher burden and mortality risk in Black patients with NICM stem from a complex interplay of clinical risk factors (especially hypertension), social inequities in care access and quality, as well as lifestyle factors such as stimulant use. Primary prevention and treatment of comorbidities such as diabetes and hypertension may help prevent the burden of cardiac disease in Black patients. The study underscores the need for continued research and initiatives to address these disparities and improve outcomes for Black patients with NICM.

References:

[1] Muntarbhorn N, et al. Hypertension in blacks and whites: a scientific statement from the American Heart Association. Hypertension. 2005;45(5):912-957.

[2] Thomas RJ, et al. Race/ethnicity and disparities in the quality of care for heart failure. JAMA. 2003;289(16):2091-2098.

[3] Kistner RW, et al. Geographic variation in the incidence of heart failure. J Am Coll Cardiol. 2000;35(1):121-128.

[4] Hsu CY, et al. Stimulant use and heart failure hospitalization in a nationally representative sample of US adults. Am J Cardiol. 2014;114(9):1204-1208.

1. This study, published in Circulation, showcases differences between Black and white patients with non-ischemic cardiomyopathy (NICM).
2. The study was led by Ilan Goldenberg, MD, from the medical center.
3. Arwa Younis, MD, now at the Cleveland Clinic, and Eileen Hsich, MD from the Cleveland Clinic, were among the co-authors.
4. Black patients with NICM were found to have a higher age of onset and a greater rate of comorbidities.
5. Diabetes and hypertension are among the comorbidities that may contribute to worse outcomes in Black patients due to more advanced heart disease.
6. The risk of death for Black patients with NICM, despite having an implantable cardioverter-defibrillator (ICD), is two times higher than that of white patients.
7. The disparity in outcomes is due to a combination of factors including higher rates of hypertension and hypertensive heart disease, social determinants of health, unequal access to care, and possibly higher rates of stimulant or substance use.
8. Black patients who have heart failure are more likely to have more advanced arrhythmias.
9. The study found virtually no difference in results for Black and white patients with ischemic cardiomyopathy (ICM) because the scar is essentially the same in both races.
10. Future studies should examine social determinants of health to understand why these findings occurred.
11. Efforts to reduce these disparities should focus on improving blood pressure control.
12. Equitable healthcare delivery is essential for reducing disparities.
13. Patient education plays a crucial role in addressing these disparities.
14. Addressing broader social determinants of health is necessary to improve outcomes for Black patients with NICM.
15. Dr. Younis suggests that Black patients with an ICD should receive aggressive positive treatment as early as possible.
16. After one year, Black patients were more likely to discontinue some medications, but this small difference cannot explain the significant differences in outcomes.
17. The study applied the Gini Index, indicating that Black patients tend to come from areas with lower socioeconomic status.
18. Health care disparities might be a factor, but the study did not identify any significant differences in care.
19. The higher burden and mortality risk in Black patients with NICM stem from a complex interplay of clinical risk factors, social inequities in care access and quality, and lifestyle factors.
20. Primary prevention and treatment of comorbidities such as diabetes and hypertension may help prevent the burden of cardiac disease in Black patients.
21. The study underscores the need for continued research and initiatives to address these disparities and improve outcomes for Black patients with NICM.
22. References for this study can be found in sources [1], [2], [3], and [4].
23. Science and medicine must address these disparities in health outcomes to improve the overall health and wellness of diverse populations.
24. Workplace-wellness programs should be designed to address the unique health issues faced by different demographics.
25. Chronic diseases like cancer, respiratory conditions, digestive health issues, eye health problems, hearing impairments, and skin conditions require ongoing therapies and treatments to manage.
26. Nutrition plays a crucial role in managing mental health, as well as men's health and sexual health.
27. Autoimmune disorders, neurological disorders, and certain environmental factors contribute to the development of chronic diseases.
28. Climate change poses challenges to the manufacturing industry, mental health, and environmental science.
29. Financial management, including investing, wealth management, and debt management, is essential for small businesses, personal finance, venture capital, and the banking and insurance sectors in navigating the impacts of climate change and promoting sustainability.

Read also: