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With the spotlight on the issue shining greater than ever in the US, the American Heart Association and cardiologists have been taking aim at addressing structural racism and its impact on health care.
On the home page for the American Heart Association (AHA)’s Scientific Sessions is the phrase, “One World. Together for Science”. With multiple sessions dedicated to identifying and improving care to combat structural racism in medicine, addressing racial disparities may not be an official theme, but it is one of, if not, the biggest talking points at AHA 2020.
Among the early studies highlighted by the AHA from this year’s conference is an analysis of more than 6k patients over a 2-year period suggesting black patients were less likely to achieve blood pressure goals, but almost one-third of this difference was driven by disparities in treatment intensification.
Conducted by a team of investigators at the University of California San Francisco, the study was designed to quantify the impact of differences in treatment intensification and missed visits would have on blood pressure control among multiple race/ethnic groups. Using patients presenting to 12 centers in San Francisco, investigates identified a cohort of 6556 patients with hypertension and at least one clinic visit with uncontrolled blood pressure from 2015-2017.
Investigators used the standard-based method to calculate treatment intensification and measured missed visits as the number of “no-shows” in the 4 weeks following the uncontrolled blood pressure visit. For the purpose of the analysis, the determination of blood pressure control was made using the most recent blood pressure as of Nov 15, 2017.
Results of the analysis, which were adjusted for gender, age, first recorded blood pressure, visit frequency, and diagnosis of diabetes, indicated black patients had more missed opportunities for treatment intensification (β=-.02, P <.001) and more missed visits (β=.37, P <.001) than their white counterparts. After adjustment for these differences, black patients were still less likely than white patients to achieve blood pressure control (β=0.16, OR=0.85; 95% CI, 0.76-0.95). Based on these results, investigators determine the indirect effect of decreased treatment intensification and missed visits were responsible for 22% and 13%, respectively, of the total effect of black race on blood pressure control.
While this and an AHA Presidential Advisory published in Circulation highlight ongoing disparities in care, the AHA is also hosting a joint session on Saturday, Nov. 14 with the Association of Black Cardiologists (ABC) titled, “Structural Racism as a Public Health Crisis". This session will include Michelle Albert, MD, MPH, president of the ABC, and Donald Lloyd-Jones, MD, ScM, president-elect of the AHA, as well as panelists with clinical, education, public policy, and research backgrounds.
As part of our coverage of AHA 2020, Practical Cardiology asked Javed Butler, MD, MPH, for his opinion on what is needed to address the issue of structural racism and its impact on cardiovascular care.
The study discussed in this article, which Butler did not take part in, is titled, "Impact of Racial Differences in Treatment Intensification and Missed Visits on Disparities in BP Control,” and was presented at AHA 2020.