Primary Care Physicians Play an Important Role in Prevention, Diagnosis and Treatment of Cardiovascular Disease – and Reducing Disparities

UH Harrington Heart & Vascular Institute Update | August 2022

Racial disparities have long been identified in cardiovascular disease (CVD) outcomes. The COVID-19 pandemic has disproportionately affected vulnerable populations and will likely result in worsening of these disparities, as has been shown in research published by HHVI physicians.¹ Vulnerable populations have higher prevalence of traditional CVD, behavioral and social risk factors.

Sadeer Al-Kindi, MD

Primary care plays a significant role in prevention, diagnosis and treatment of CVD.

To help reduce cardiovascular health disparities, consider:

• Enhanced cardiovascular risk communication can result in improved risk perception and improvement in utilization of guideline-directed therapies.
• Intensive culturally sensitive lifestyle counseling can improve CVD risk factors.
• Building an environment of trust with patients through continuity of care and open communication.
• Examining patient preferences and addressing adherence to medications.
• Addressing food security, transportation, access to care and utilization of social services when indicated.
• Investigation and appropriate treatment of psychosocial stressors that may contribute to cardiovascular risk.
• Multidisciplinary care models can ensure equitable high-quality healthcare delivery.
• Establish race-specific outcome data dashboards and quality reports to improve equity.
• Building systems of care aimed for CVD prevention and management in socially vulnerable populations.
• Diversification of the healthcare workforce.
• Community engagement and outreach is an important aspect to to reduce CVD health disparities

Specific areas of focus include:

• Improved utilization of primordial and primary prevention strategies for atherosclerotic cardiovascular disease (e.g. weight loss, exercise, statins). Minority patients are less likely to receive counseling and preventive pharmacotherapy.
• Improved utilization of guideline-directed medical therapy in patients with myocardial infarction and stroke (use of antiplatelet therapy, lipid-lowering therapy, etc). Minority patients are less likely to receive guideline-directed secondary prevention treatments.
• Improved utilization of guideline-directed medical therapy in heart failure. Minority patients are less likely to receive optimal heart failure therapies and are at increased risk for adverse outcomes.
• Timely referral to specialty care for valvular heart disease, advanced heart failure, and device therapies. Minority patients are less likely to be referred for specialty cardiovascular care and are less likely to receive advanced treatments.
• Equitable prescription and access to medications with proven cardiometabolic benefit (SGLT2i, GLP1RA, etc). Black men and women with diabetes are up to 50 percent less likely to receive SGLT2i and GLP1RA.

To discuss further, please feel free to contact me: Sadeer.Al-Kindi@UHhospitals.org.

1  https://www.mayoclinicproceedings.org/article/S0025-6196(22)00445-1/fulltext