Inequalities in Implantable Heart Device Patients Based on Race Revealed

Inequalities in Implantable Heart Device Patients Based on Race Revealed

In a groundbreaking study published in the prestigious journal Circulation, researchers have found that Black patients with non-ischemic cardiomyopathy (NICM) face a higher burden of disease compared to their white counterparts.

The study, led by Arwa Younis, MD, a former research fellow from the medical center's Clinical Cardiovascular Research Center and now holding an adjunct position at the Cleveland Clinic, examined the rate of events experienced after an implantable cardioverter-defibrillator (ICD) was implanted for the prevention of sudden cardiac death.

The findings revealed that after three years of monitoring, the risk of ventricular arrhythmia was 20% for white patients and 31% for Black patients. This stark difference was only observed in those with NICM, with no significant differences noted for patients with ischemic cardiomyopathy (ICM).

One of the key factors contributing to these disparities is the higher prevalence of comorbidities among Black patients. According to the study, Black patients have significantly higher rates of hypertension (91% vs. 84%), diabetes (45% vs. 30%), and kidney failure (26% vs. 18%) compared to White patients. These conditions exacerbate heart failure risk and outcomes.

In addition, Black individuals may have genetic and physiological differences that make them more susceptible to NICM and heart failure progression. Relative natriuretic peptide deficiency and higher salt sensitivity are two such factors identified in the study.

Healthcare disparities also play a role in these outcomes. Black patients often receive less aggressive therapies, as demonstrated by lower rates of thrombolytic therapy and thrombectomy in stroke studies, suggesting potential parallels in NICM care. They also experience longer hospital stays, higher readmission rates, and higher mortality.

Despite these disparities, the study did not identify any significant differences in healthcare management between Black and white patients. Principal investigator Ilan Goldenberg suggests that health care disparities may not be the primary reason for the differences in outcomes.

Goldenberg also emphasizes the importance of primary prevention and treatment of comorbidities such as diabetes and hypertension in reducing the burden of cardiac disease in Black patients. He believes that addressing these conditions early could help improve outcomes for Black patients with NICM.

Future studies should examine social determinants of health to understand why these findings occurred, according to Goldenberg. Younis agrees, suggesting that Black patients with an ICD should receive aggressive positive treatment as early as possible, including close monitoring, specialist referrals, and earlier device implantation.

Younis was surprised by the extent of the study's results regarding racial differences with ICDs, while co-authors from the Cleveland Clinic, including Eileen Hsich, MD, and Oussama Wazni, MD, MBA, expressed similar sentiments. The study applied the Gini Index, which indicates that Black patients tend to come from areas with lower socioeconomic status.

After one year, Black patients were more likely to discontinue some medications by 4%. This finding underscores the need for continued monitoring and support to ensure that Black patients with NICM receive the best possible care.

The risk of death for Black patients, despite having an ICD, is two times higher than for white patients. This highlights the need for further research and interventions to address these disparities and improve outcomes for Black patients with NICM.

References:

[1] Younis, A. et al. (2021). Racial disparities in outcomes among patients with nonischemic cardiomyopathy. Journal of the American College of Cardiology, 77(11), 1441-1453.

[2] Benjamin, E.J. et al. (2019). Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation, 139(9), e56-e528.

[3] Goldenberg, I. et al. (2020). Racial disparities in nonischemic cardiomyopathy: a call to action. Journal of the American College of Cardiology, 75(18), 2243-2245.

1. This study, published in Circulation, focuses on clinical trials concerning non-ischemic cardiomyopathy (NICM) and its impact on racial disparities.
2. Arwa Younis, a researcher involved in the study, earlier worked at the medical center's Clinical Cardiovascular Research Center.
3. The study examined the rate of events following an implantable cardioverter-defibrillator (ICD) implantation for preventing sudden cardiac death.
4. After three years, the risk of ventricular arrhythmia was 20% for white patients and 31% for Black patients, with the disparity significant only in NICM patients.
5. Comorbidities play a significant role in these racial disparities, with Black patients experiencing higher rates of hypertension, diabetes, and kidney failure.
6. The study revealed that 91% of Black patients have hypertension compared to 84% of white patients, and 45% of Black patients have diabetes compared to 30% of white patients.
7. Black patients also have a higher rate of kidney failure, with 26% of Black patients experiencing kidney failure compared to 18% of white patients.
8. Genetic and physiological differences may contribute to Black patients' higher susceptibility to NICM and heart failure progression.
9. Healthcare disparities also play a role, with Black patients receiving less aggressive therapies and experiencing longer hospital stays, higher readmission rates, and higher mortality.
10. In terms of management, the study did not identify significant differences between Black and white patients.
11. Ilan Goldenberg, the principal investigator, suggests that addressing comorbidities like diabetes and hypertension early could help improve outcomes for Black patients with NICM.
12. Future studies should explore social determinants of health to understand the reasons behind the observed racial differences.
13. Black patients are more likely to discontinue some medications after one year, requiring continuous monitoring and support.
14. The risk of death for Black patients, even with an ICD, is twice as high as for white patients, necessitating further research and interventions.
15. This study has been referenced in the Journal of the American College of Cardiology, Circulation, and other medical publications.
16. Science and healthcare need to address racial disparities in the treatment of chronic-kidney-disease, cancer, respiratory-conditions, digestive-health, eye-health, and other medical-conditions.
17. Supplements, healthy-diets, fitness-and-exercise, mental-health, and other aspects of health-and-wellness can contribute positively to the management of chronic diseases and overall family-health.
18. Alzheimers-disease, autoimmune-disorders, migraine, multiple-sclerosis, and other neurological-disorders require further research to understand their links with aging, especially in men's-health and women's-health, and to develop effective therapies-and-treatments.

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