Disparities among heart failure treatment have heavily impacted marginalized groups, creating a need for transformative quality patient care solutions.
Biykem Bozkurt, M.D., Ph.D., FACC
Editor-in-Chief, JACC: Heart Failure
Around 6 million Americans live with heart failure, a lifelong condition that causes the heart muscle to weaken its pumping process throughout the body. Among these 6 million, minority populations have a higher risk of mortality or hospitalization due to healthcare disparities and socioeconomic barriers that prevent equitable patient care and outcomes.
Such barriers — including inadequate healthcare coverage, poverty, unemployment, inflexibility in work hours, housing/food insecurity, transportation, healthcare biases, and lack of social support — create obstacles toward preventing and treating cardiovascular disease, and in particular heart failure, in marginalized communities. The term “population health” has recently expanded to include combating racial, gender, and income biases within clinician-based care. Here are up-to-date initiatives and protocols for improving clinician-patient relationships and battling health inequities.
Digital transformation
Telehealth and flexible-based online care provide faster access to care at a lower cost. Remote care, personal monitoring, and digital communication platforms allow patients to ask questions about their care, prognosis, and strategies to improve their well-being right from their own homes. The COVID-19 pandemic has also shed light on virtual nursing and treatment services to broaden patient access in underserved geographical locations.
Community-based programs and partnership collaboration
Meeting patients where they are bridges the gap in access to medicine, care coordination, and improving accessible healthcare coverage. Research in the Journal of the American College of Cardiology concluded that uninsured populations, which typically disproportionately impact Black and Latino patients, present late with advanced heart failure and have higher rates of mortality due to a delay in timely diagnosis, follow-up, treatment, or care coordination. These individuals also can lack economic stability and social support, meaning inflexibility to take off work or delegate family responsibilities to attend medical appointments, thus increasing their risk of developing heart failure or having more advanced heart failure. By meeting these patients where they are and partnering with local schools, churches, grocery stores and barber shops, patients have more opportunities to stay engaged and educated on appropriate diagnostic steps toward improving their health.
Clinical research
Data gathering on diverse patient populations via medical registries and pragmatic clinical study designs can help scope national focus areas for health equity and support hospitals to understand equity gaps. This data is used to develop educational and actionable tools for clinicians and to measure outcomes of efforts to close gaps in care access. Professional medical societies and government health agencies have launched many programs stemming from collected data that focus on quality improvement initiatives to ensure equal access to care for underserved populations. These include not only helping patients directly, but also educating clinicians on social determinants of health and how factors like access to healthy food, adequate housing, and medical treatment can all impact heart disease outcomes. Transformative research can give healthcare professionals insight for actionable improvements toward treatment prognosis in these communities over time.
Clinical care bias training and onsite treatment coordination
Through educational curriculum and onsite training programs in hospitals, clinicians have adequate guidance, clinical alerts, and decision aids for timely, appropriate care and therapies. Some hospitals have incorporated risk prevention management tools that integrate health equity values to improve timely treatment and identify disparities and social determinants of health. Multidisciplinary care coordination has diversified care teams to include multiple specialists and care team members needed to effectively treat a patient and create a more streamlined and targeted treatment plan. These resources and changes in clinician team arrangements equip cardiovascular professionals with proper tools to improve the implementation of care without delay.
Health equity has increasingly become integrated into implementation strategies among cardiology societies, federal agencies, and healthcare institutions. To enhance the support for research and innovation in mitigating disparities, healthcare leadership must prioritize health equity as an essential component of quality cardiovascular care and equip clinicians with risk prevention, treatment, and timely diagnostic strategies. Marginalized communities are inequitably impacted in advanced stages of heart failure, causing a need for improved clinician-patient care strategies, such as identifying treatment goals, self-care options, and education on timely diagnosis and treatment. Further, healthcare institutions need to advocate for infrastructure, coverage, social support, and policy changes to address systematic, unjust societal and structural factors pushing health inequity.
The future of health is evolving to help address population health; however, more research, advocacy, and policy changes must be developed to achieve health equity and eliminate heart failure disparities and adverse outcomes for marginalized communities.