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Overcoming disparities in access to care for communities of color

This year, more than 5 million Americans will be diagnosed with Heart Valve Disease. All too often, for Black patients with certain forms of the disease this can be a death sentence, with patients from minority communities facing significantly higher mortality rates than their white counterparts.

The most common form of this disease is aortic stenosis (AS), where the aortic valve narrows and weakens the heart. While common, AS can be deadly, and one in six patients will have a more aggressive form called symptomatic severe aortic stenosis (SSAS), that can be fatal within two years without treatment.

Diseases like SASS and other chronic diseases lay bare stark inequities in our health care system, in which our Black patients are disproportionately impacted. When we see patients with SSAS, treatment options include two approaches to repair their failing valve, one that involves open-heart surgery and one that is minimally invasive. The latter, transcatheter aortic valve replacement (TAVR) provides eligible patients with quicker procedure times and a shorter recovery. All in all, this means they can spend less time in the hospital, compared to the standard surgical aortic valve replacement (SAVR).

Yet, Black patients with SSAS are not being given the same treatment options as their white counterparts and are being left behind when it comes to the benefits of TAVR. This gap is reflected by the nearly a three-fold difference between the likelihood of non-Black patients receiving TAVR compared to white patients. In 2018 alone, only 14.4% of Black patients had a TAVR procedure compared to 24.4% of white patients with the same diagnosis. Furthermore, major randomized clinical trials of TAVR are falling short in including adequate representation of Black patients all together.

The effects of this disparity aren’t simply unjust, they are possibly fatal – spelling out a much greater risk of death and hospital readmission following surgery.

Disparities like this don’t just impact heart valve disease patients. They are insidious within our care system. In Baton Rouge, I’ve seen these disparities brought into sharp focus by the Covid-19 pandemic. Significant issues in access exist across the care continuum, with Black patients traveling farther and facing more barriers to receiving the vaccine since their neighborhoods are being left out of the roll-out. Everyday families are choosing between getting the care they need or missing a full day of work at the cost of losing critical income. This is the same pattern we are seeing in how Black patients and those impacted by poverty are accessing TAVR centers, or lack thereof. It comes as no surprise that thes odds of getting TAVR increase 10% for every $10,000 increase in income.

While there is much to be done to close the gap, it is more important than ever to start making progress. We know that inequities in care for AS have increased over the last seven years, and the rates of heart valve disease are only expected to grow as the population ages.

Uncovering these disparities is just first step working towards equal access and quality of care for communities of all races. National and local initiatives can help carry this out in full stride. With the AS Disparities of Care Pilot Program, four health systems across the country are working to address inequalities within their communities to create nationwide change in heart valve disease care.

By prioritizing patient awareness, we can help patients, who might otherwise have been undiagnosed and undertreated, understand the signs and symptoms of heart valve disease.  Further, by meeting patients where they are primed to receive information, we can help them understand their full range of options for AS so that they are equipped to be an informed decision-maker for their health.

Photo: FG Trade, Getty Images

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