Racial Disparities in Cardiovascular Care: A Review of Culprits and Potential Solutions

Springer Science and Business Media LLC - Tập 1 Số 3 - Trang 171-180 - 2014
Capers, Quinn1, Sharalaya, Zarina1
1Division of Cardiovascular Medicine, The Ohio State University College of Medicine, Columbus, USA

Tóm tắt

Cardiovascular disease is the leading cause of death for white and black Americans. Despite the presence of therapies that improve survival and quality of life in cardiac patients, African-Americans continue to have the worst heart disease survival rates of all racial groups. The literature has described racial disparities in cardiovascular care for at least 25 years. We review the current status of racial disparities in four areas of cardiovascular care: automatic implantable cardioverter-defibrillator (AICD) implantations in patients at risk for sudden cardiac death, cardiac resynchronization therapy with defibrillator (CRT-D) implantation in patients with severely depressed left ventricular function and refractory heart failure, reperfusion therapy in patients presenting with acute myocardial infarction, and revascularization in patients with critical limb ischemia. We will discuss potential culprits for these disparities with a particular focus on hospital quality, physician bias, and the relative lack of diversity among cardiovascular physicians in the USA. Finally, we will discuss strategies already in progress that hold promise to reduce or eliminate racial disparities in cardiovascular care.

Tài liệu tham khảo

National Vital Statistics. Centers for Disease Control. 2010. citation_journal_title=JAMA; citation_title=Racial inequalities in the use of procedures for patients with ischemic heart disease in Massachusetts; citation_author=MB Wenneker, AM Epstein; citation_volume=261; citation_publication_date=1989; citation_pages=253-257; citation_doi=10.1001/jama.1989.03420020107039; citation_id=CR2 citation_journal_title=JAMA; citation_title=Racial differences in the use of revascularization procedures after coronary angiography; citation_author=JZ Ayanian, IS Udvarhelyi, CA Gatsonis, CL Pashos, AM Epstein; citation_volume=269; citation_issue=20; citation_publication_date=1993; citation_pages=2642-2646; citation_doi=10.1001/jama.1993.03500200056033; citation_id=CR3 citation_journal_title=Circulation; citation_title=Racial and ethnic disparities in care—the perspectives of cardiologists; citation_author=N Lurie, A Fremont, AK Jain; citation_volume=111; citation_publication_date=2005; citation_pages=1264-1269; citation_doi=10.1161/01.CIR.0000157738.12783.71; citation_id=CR4 citation_journal_title=J Grad Med Educ; citation_title=Residents’ awareness of racial and ethnic disparities in cardiovascular care; citation_author=SR Greysen, B Siegel, V Sears; citation_volume=3; citation_issue=3; citation_publication_date=2011; citation_pages=417-420; citation_doi=10.4300/JGME-D-10-00190.1; citation_id=CR5 citation_title=Racial and ethnic disparities in diagnosis and treatment: a review of the evidence and a consideration of causes; citation_inbook_title=Unequal treatment: confronting racial and ethnic disparities in health care; citation_publication_date=2003; citation_pages=417-454; citation_id=CR6; citation_author=HJ Geiger; citation_publisher=National Academies Press citation_journal_title=Circulation; citation_title=Randomized comparison of anti-arrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest: the Cardiac Arrest Study Hamburg; citation_author=KH Kuck, R Cappato, J Siebels; citation_volume=102; citation_publication_date=2000; citation_pages=748-754; citation_doi=10.1161/01.CIR.102.7.748; citation_id=CR7 citation_journal_title=Am J Cardiol; citation_title=Impact of the multicenter automatic defibrillator implantation trial on implantable cardiac defibrillator indication trends; citation_author=SL Higgins; citation_volume=83; citation_publication_date=1999; citation_pages=79D-82D; citation_doi=10.1016/S0002-9149(98)01007-8; citation_id=CR8 citation_journal_title=Circulation; citation_title=Racial disparity in cardiac procedures and mortality among long-term survivors of cardiac arrest; citation_author=PW Groeneveld, PA Heidenreich, AM Garger; citation_volume=108; citation_publication_date=2003; citation_pages=286-291; citation_doi=10.1161/01.CIR.0000079164.95019.5A; citation_id=CR9 citation_journal_title=Am Heart J; citation_title=Variation in cardiac procedure use and racial disparity among Veterans Affairs Hospitals; citation_author=PW Groenenveld, GB Kruse, Z Chen; citation_volume=153; citation_publication_date=2007; citation_pages=320-327; citation_doi=10.1016/j.ahj.2006.10.032; citation_id=CR10 citation_journal_title=JAMA; citation_title=Sex and racial differences in the use of implantable cardioverter-defibrillators among patients hospitalized with heart failure; citation_author=AF Hernandez, GC Fonarow, L Liang; citation_volume=298; citation_issue=13; citation_publication_date=2007; citation_pages=1525-1532; citation_doi=10.1001/jama.298.13.1525; citation_id=CR11 citation_journal_title=Circulation; citation_title=ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons; citation_author=AE Epstein, JP DiMarco, KA Ellenbogen; citation_volume=117; citation_issue=21; citation_publication_date=2008; citation_pages=e350-e408; citation_doi=10.1161/CIRCUALTIONAHA.108.189742; citation_id=CR12 citation_journal_title=Am Heart J; citation_title=Educational videos to reduce racial disparities in ICD therapy Via Innovative Designs (VIVID): a randomized clinical trial; citation_author=KL Thomas, LO Zimmer, D Dai; citation_volume=166; citation_issue=1; citation_publication_date=2013; citation_pages=157-163; citation_doi=10.1016/j.ahj.2013.03.031; citation_id=CR13 citation_journal_title=JACC; citation_title=Are racial/ethnic gaps in the use of cardiac resynchronization therapy narrowing?; citation_author=ZJ Eapen, S Al-Khatib, RD Lopes; citation_volume=60; citation_issue=16; citation_publication_date=2012; citation_pages=1577-1578; citation_doi=10.1016/j.jacc.2012.06.024; citation_id=CR14 citation_journal_title=Heart Rhythm; citation_title=Ethnic and racial disparities in cardiac resynchronization therapy; citation_author=SA Farmer, JN Kirkpatrick, PA Heidenreich; citation_volume=6; citation_issue=3; citation_publication_date=2009; citation_pages=325-331; citation_doi=10.1016/j.hrthm.2008.12.018; citation_id=CR15 citation_journal_title=JACC; citation_title=ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to update the 2001 Guidelines for the Evaluation and Management of Heart Failure); citation_author=SA Hunt; citation_volume=46; citation_publication_date=2005; citation_pages=e1-e82; citation_doi=10.1016/j.jacc.2005.08.022; citation_id=CR16 citation_journal_title=N Engl J Med; citation_title=Recent trends in acute coronary heart disease—mortality, morbidity, medical care, and risk factors: the Minnesota Heart Survey Investigators; citation_author=PG McGovern, JS Pankow, E Shahar; citation_volume=334; citation_publication_date=1996; citation_pages=884-890; citation_doi=10.1056/NEJM199604043341403; citation_id=CR17 citation_journal_title=Am Heart J; citation_title=Underutilization of reperfusion therapy in eligible African Americans with acute myocardial infarction: role of presentation and evaluation characteristics; citation_author=A Manhapra, JG Canto, HV Barron; citation_volume=142; citation_publication_date=2001; citation_pages=604-610; citation_doi=10.1067/mhj.2001.118464; citation_id=CR18 citation_journal_title=JAMA; citation_title=Racial variation in cardiac procedure use and survival following acute myocardial infarction in the Department of Veterans Affairs; citation_author=ED Peterson, SM Wright, J Daley; citation_volume=271; citation_issue=15; citation_publication_date=1994; citation_pages=1175-1180; citation_doi=10.1001/jama.1994.03510390045028; citation_id=CR19 citation_journal_title=Crit Pathw Cardiol; citation_title=Racial disparities in stress test utilization in an emergency department chest pain unit; citation_author=AM Napoli, EK Choo, J Dai; citation_volume=12; citation_issue=1; citation_publication_date=2013; citation_pages=9-13; citation_doi=10.1097/HPC.0b013e31827c9a86; citation_id=CR20 citation_journal_title=Am Heart J; citation_title=The association between patient race, treatment, and outcomes of patients undergoing contemporary percutaneous coronary intervention: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2); citation_author=S Khambatta, M Seth, HS Rosman; citation_volume=165; citation_issue=6; citation_publication_date=2013; citation_pages=893-901; citation_doi=10.1016/j.ahj.2013.02.030; citation_id=CR21 citation_journal_title=Arch Surg; citation_title=The influence of race on the use of surgical procedures for treatment of peripheral vascular disease of the lower extremities; citation_author=E Guadagnoli, JZ Ayanian, G Gibbons; citation_volume=130; citation_issue=4; citation_publication_date=1995; citation_pages=381-386; citation_doi=10.1001/archsurg.1995.01430040043006; citation_id=CR22 citation_journal_title=J Vasc Surg; citation_title=The adverse effects of race, insurance status, and low income on the rate of amputation in patients presenting with lower extremity ischemia; citation_author=MH Eslami, M Zayaruzny, GA Fitzgerald; citation_volume=45; citation_publication_date=2007; citation_pages=55-59; citation_doi=10.1016/j.jvs.2006.09.044; citation_id=CR23 citation_journal_title=Atherosclerosis; citation_title=Ethnic differences in lower limb revascularization and amputation rates. Implications for the aetiopathology of atherosclerosis?; citation_author=N Ahmad, GN Thomas, C Chan; citation_volume=233; citation_publication_date=2014; citation_pages=503-507; citation_doi=10.1016/j.atherosclerosis.2013.12.039; citation_id=CR24 citation_journal_title=Vasc Endovasc Surg; citation_title=Racial/ethnic disparities in amputation and revascularization: a nationwide inpatient sample study; citation_author=K Hughes, S Seetahal, T Oyetunji; citation_volume=48; citation_issue=1; citation_publication_date=2014; citation_pages=34-37; citation_doi=10.1177/1538574413510618; citation_id=CR25 citation_journal_title=JAMA Surg; citation_title=Influence of race on the management of lower extremity ischemia: revascularization vs amputation; citation_author=TS Durazzo, S Frencher, R Gusberg; citation_volume=148; citation_issue=7; citation_publication_date=2013; citation_pages=617-623; citation_doi=10.1001/jamasurg.2013.1436; citation_id=CR26 citation_journal_title=N Engl J Med; citation_title=The effect of race and sex on physicians’ recommendations for cardiac catheterization; citation_author=K Schulman, J Berlin, W Harless; citation_volume=340; citation_publication_date=2003; citation_pages=618-626; citation_doi=10.1056/NEJM199902253400806; citation_id=CR27 citation_journal_title=J Gen Int Med; citation_title=Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients; citation_author=AR Green, DR Carney, DJ Pallin; citation_volume=22; citation_publication_date=2007; citation_pages=1231-1238; citation_doi=10.1007/s11606-007-0258-5; citation_id=CR28 citation_title=The Implicit Association Test at age 7: a methodological and conceptual review; citation_inbook_title=Automatic processes in social thinking and behavior; citation_publication_date=2007; citation_id=CR29; citation_author=BA Nosek; citation_author=AG Greenwald; citation_author=MR Banaji; citation_publisher=Psychology citation_journal_title=Ann Fam Med; citation_title=Clinicians’ implicit ethnic/racial bias and perceptions of care among black and Latino patients; citation_author=IV Blair, JF Steiner, DL Fairclough; citation_volume=11; citation_issue=1; citation_publication_date=2013; citation_pages=43-52; citation_doi=10.1370/afm.1442; citation_id=CR30 citation_journal_title=Am J Public Health; citation_title=The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infections, attention deficit hyperactivity disorder, and asthma; citation_author=JA Sabin, AG Greenwald; citation_volume=102; citation_issue=5; citation_publication_date=2012; citation_pages=988-995; citation_doi=10.2105/AJPH.2011.300621; citation_id=CR31 citation_journal_title=JAMA; citation_title=Racial and ethnic differences in time to acute reperfusion therapy for patients hospitalized with myocardial infarction; citation_author=EH Bradley, J Herrin, Y Wang; citation_volume=292; citation_publication_date=2004; citation_pages=1563-1572; citation_doi=10.1001/jama.292.13.1563; citation_id=CR32 citation_journal_title=N Engl J Med; citation_title=Delayed time to defibrillation after in-hospital cardiac arrest; citation_author=PS Chan, HM Krumholz, G Nichol; citation_volume=358; citation_issue=1; citation_publication_date=2008; citation_pages=9-17; citation_doi=10.1056/NEJMoa0706467; citation_id=CR33 citation_journal_title=JAMA; citation_title=Racial differences in survival after in-hospital cardiac arrest; citation_author=PS Chan, G Nichol, HM Krumholz; citation_volume=302; citation_issue=11; citation_publication_date=2009; citation_pages=1195-1201; citation_doi=10.1001/jama.2009.1340; citation_id=CR34 citation_journal_title=Ann Surg; citation_title=Do differences in hospital and surgeon quality explain racial disparities in lower-extremity vascular amputations?; citation_author=SE Regenbogen, AA Gawande, SR Lipsitz; citation_volume=250; citation_publication_date=2009; citation_pages=424-431; citation_id=CR35 citation_journal_title=Am J Public Health; citation_title=Racial differences in access to high-quality cardiac surgeons; citation_author=DB Mukamel, AS Murthy, DL Weimer; citation_volume=90; citation_issue=11; citation_publication_date=2000; citation_pages=1774-1777; citation_doi=10.2105/AJPH.90.11.1774; citation_id=CR36 citation_journal_title=Arch Surg; citation_title=Racial and ethnic differences in the use of high-volume hospitals and surgeons; citation_author=AJ Epstein, BH Gray, M Schlesinger; citation_volume=145; citation_issue=2; citation_publication_date=2010; citation_pages=179-186; citation_doi=10.1001/archsurg.2009.268; citation_id=CR37 citation_journal_title=JAMA Surg; citation_title=Explaining racial disparities in outcomes after cardiac surgery: the role of hospital quality; citation_author=G Rangrass, AA Ghaferi, JB Dimick; citation_volume=149; citation_issue=3; citation_publication_date=2014; citation_pages=223-227; citation_doi=10.1001/jamasurg.2013.4041; citation_id=CR38 United States Census Bureau: state and county quick facts. 2011. U.S. Department of Health and Human Services. The rationale for diversity in the health professions: a review of the evidence. 2006. http://bhpr.hrsa.gov/healthworkforce/reports/diversityreview evidence.pdf. (accessed 22 March 2014). citation_journal_title=Acad Med; citation_title=Survey of care for the underserved: a control group study of practicing physicians who were graduates of The Ohio State University College of Medicine Premedical Postbaccalaureate Training Program; citation_author=L McDougle, DP Way, YL Rucker; citation_volume=85; citation_publication_date=2010; citation_pages=36-40; citation_doi=10.1097/ACM.0b013e3181c46f35; citation_id=CR41 Association of American Colleges, diversity in the physician workforce, facts and figures tables. 2010. citation_journal_title=JAMA; citation_title=Graduated medical education, 2009–2010; citation_author=SE Brotherton, SI Etzel; citation_volume=304; citation_publication_date=2010; citation_pages=1255-1270; citation_doi=10.1001/jama.2010.1273; citation_id=CR43 National Center for Education Statistics. Common core of data, 2006-2007. citation_journal_title=Circulation; citation_title=Racial and ethnic differences in the treatment of acute myocardial infarction: findings from the Get with the Guidelines-Coronary Artery Disease program; citation_author=MG Cohen, GC Fonarow, ED Peterson; citation_volume=121; citation_publication_date=2010; citation_pages=2294-2301; citation_doi=10.1161/CIRCULATIONAHA.109.922286; citation_id=CR45 citation_journal_title=J Health Care Qual; citation_title=A quality improvement framework for equity in cardiovascular care: results of a national collaborative; citation_author=B Siegel, V Sears, JK Bretsch; citation_volume=34; citation_issue=2; citation_publication_date=2012; citation_pages=32; citation_doi=10.1111/j.1945-1474.2011.00196.x; citation_id=CR46 citation_journal_title=J Grad Med Ed; citation_title=Successful efforts to increase diversity in a cardiology fellowship training program; citation_author=A Auseon, AJ Kolibash, Q Capers; citation_volume=5; citation_issue=3; citation_publication_date=2013; citation_pages=481-485; citation_doi=10.4300/JGME-D-12-00307.1; citation_id=CR47 citation_journal_title=J Am Coll Cardiol; citation_title=The coalition to reduce racial and ethnic disparities in cardiovascular disease outcomes (credo): why credo matters to cardiologists; citation_author=CW Yancy, TY Wang, HO Ventura, IL Piña, K Vijayaraghavan, KC Ferdinand; citation_volume=57; citation_issue=3; citation_publication_date=2011; citation_pages=245-252; citation_doi=10.1016/j.jacc.2010.09.027; citation_id=CR48