Research, advocacy and education must "close the gaps" in cardiovascular health disparities

Research, advocacy and education must "close the gaps" in cardiovascular health disparities among races, an American Heart Association writing group reports in today's special disparities issue of Circulation: Journal of the American Heart Association.

"Discovering the full spectrum of cardiovascular disease: The minority health summit" is an executive summary based on reports from a meeting held in October 2003 in Atlanta, Ga.

"Meeting attendees reviewed medical literature to uncover the extent of known disparities in cardiovascular health and treatment and collaborated on describing what needs to be done to close the gaps," said Clyde W. Yancy, M.D., lead author of the summary and professor of internal medicine and cardiology at University of Texas Southwestern Medical Center in Dallas.

"These recommendations are based on what we already know and what we need to develop to make a positive impact on health disparities," Yancy said. "The recommendations not only address scientific issues behind cardiovascular health care disparities, but also social issues that could impede access to care, knowledge and research."

For example, the group cited evidence for disparities in cardiovascular disease from a Kaiser Family Foundation/American College of Cardiology Foundation report that showed thrombolytic therapy (clot-busting drugs given to treat a heart attack) was given 50 percent less often in African Americans compared with whites. Furthermore, minorities were less likely to have cardiac catheterization or bypass surgery than whites even after accounting for differences in age, insurance, disease severity or other health problems.

"We also wanted to highlight the striking confluence of known risk factors for heart disease and stroke in minority populations – especially hypertension, obesity and diabetes," Yancy said. "We are concerned that minority communities may be at the highest risk for heart disease and stroke. Proactive measures are needed to reduce their risk."

Robert O. Bonow, M.D., chairman of the summit and past president of the American Heart Association, said the association has an aggressive goal to reduce coronary heart disease, stroke and risk by 25 percent by 2010.

"Without improving these disparities in access to care and health information we will never achieve the goal of improving outcomes for everybody in the U.S," said Bonow, chief of cardiology at Northwestern Memorial Hospital in Chicago, whose editorial on the topic appears in the same Circulation issue.

"The reason for creating a meeting was not merely to discuss the problem, which has been done before, but to try to create a blueprint of the next steps that organizations, including the American Heart Association, need to take both on their own and in partnership with other groups," he said.

The summary also cites an Institute of Medicine report that defines "major contributors" to health care disparities including the health care delivery system. The report concluded that the system may lack cultural sensitivity, may include communication barriers for non-English-speaking patients, or is too difficult to access due to insurance and/or financial limitations.

"Significant cultural diversity exists in this country and cultural awareness, more precisely termed cultural competence, is at the core of any effort to fully address disparities in CVD," Bonow said.

Under the research category, the authors discuss the need for genetic-based studies that would identify populations at high risk for heart disease and stroke. Environmental research is needed to find out how minority communities use health care services and whether outreach and risk factor modification programs are effective in these communities.

Minority participation in research is also inadequate, according to the report, and is necessary to increase the validity of studies. The report calls for developing more minority research investigators, as well as encouraging minority participation in these studies.

The group felt that organizations should advocate for funding needed to identify gaps in access to quality health care services; to pursue systems and policy level research to improve quality of care; and to focus on reducing obesity and other risk factors. Primary prevention services are critical and should be encouraged and reimbursed. These include community outreach programs in school, work and faith-based settings. And all Americans, regardless of their race, socio-economic status or where they live, need to have access to evidence-based cardiovascular care.

To educate the public and the government, the report supports the American Heart Association's and other public health entities' in their continued emphasis on cardiovascular disease risk factors and outcomes among ethnic populations.

"There are some articles in this issue in Circulation that underscore another aspect of the problem," Bonow said. "Many health care providers do not recognize that there are health disparities. Among the ones that do, many don't believe that these problems are occurring in their own offices. There is a clear need to educate healthcare providers as well as the public and legislators."

Among educational recommendations the group cites the need to reach minorities with educational information and materials. More health care providers should be receiving training in cultural competency, as well as have culturally sensitive educational health care materials in different languages available for their patients.

"The underlying causes for health care disparities are deeply rooted in our society and are not merely medical issues," Bonow said. "Thus, health care professionals and scientists alone cannot solve them. But the community of medicine and science, when challenged and mobilized, can be a powerful force that can help to implement changes through education, research and advocacy." Co-authors of the executive summary are Emelia J. Benjamin, M.D., Sc.M., and Rosalind P. Fabunmi, Ph.D.