Equal Access to Heart Failure Treatment for All
If you have heart failure, the right treatment can make all the difference in improving your symptoms and extending your life. Treatments range from lifestyle changes like cutting back on salt to a heart transplant for the most serious cases of heart failure.
In the U.S., heart failure is more common among Black and Hispanic people than among white people. Black people are more likely to have heart failure at a younger age and lose their lives to the disease. Kelly McCants, MD, a cardiologist with Norton Healthcare in Louisville, KY, calls it the “40/40 club.”
“Forty percent of heart failure diagnoses in our hospital happen in African Americans under the age of 40.” McCants says this startling statistic is similar to heart failure rates in other big cities with large Black populations.
Besides these health challenges, Black and Latino people face major hurdles to getting treatment for heart failure. Research shows these groups are less likely to get:
- Care from a cardiologist when they’re in the hospital and critically ill from heart failure
- Advanced heart failure therapies like a heart transplant
- A doctor’s referral for a cardiac rehabilitation program
- Surgery to implant cardiac devices
The reasons for these health disparities are complex. Things like your health insurance status, bias in the health care system, and lack of representation in clinical research all play a role. Addressing these barriers can help Black and Hispanic people gain equal access to treatment.
Removing Barriers to Heart Failure Treatment
Know your numbers
The first step to accessing treatment for heart failure is to understand your chances of getting the disease. You’re more likely to have heart failure if you have conditions like high blood pressure or diabetes. And some minority groups live with these conditions more often.
McCants, who is also executive director of Norton Healthcare’s Advanced Heart Failure and Recovery Program and the Institute for Health Equity, says many Black and Hispanic people don’t know if they have high blood pressure, a major cause of heart failure. “We’re usually unaware of our [blood pressure] targets in terms of the 120 over 80.”
High blood pressure is a “silent killer,” so the only way to know if you have it is to check your numbers routinely. Your doctor can tell you how often to check your blood pressure. You can do it quickly at the doctor’s office, a pharmacy, or – with the right equipment – even at home.
Paying for health care
When your doctor says you have heart failure, one of the first questions you may ask is how you’re going to afford heart failure treatment. A heart failure diagnosis often requires expensive medicines, frequent hospital visits, and close tracking by doctors.
The cost of health care is a critical concern for many people, especially for those who have less money. Data show that people of color people are more often uninsured or underinsured and live in poverty than white people.
“When patients are faced with a choice of either taking medication or having money for food, that’s where it becomes a very difficult balance,” says Jim Cheung, MD, a cardiologist and electrophysiologist with Weill Cornell Medicine in New York.
The more serious your condition, the more expensive treatment can get. One example: a heart transplant. If you have advanced heart failure, you may need a new heart from a donor, a surgery that costs more than $1.6 million. Transplant centers need proof of health insurance or other financial resources before they will even put you on a waitlist for a new heart.
The Affordable Care Act (ACA) and Medicaid expansion have improved access to treatment for many. One study found a 30% increase in the number of African Americans added to heart transplant lists in states that expanded Medicaid. The number of Hispanics on these lists grew as well but only a little.
Bias in the health care system
Your race or ethnicity can also impact how health care professionals treat you for medical conditions, including heart failure. For decades, scientific research has shown that minority groups have fewer medical procedures and get poorer care than white people. This is due, in part, to unconscious bias by health care professionals.
Researchers looked at how your race influences doctors’ decision-making about advanced heart failure therapies. Overall, race doesn’t seem to play a role in whether doctors suggest different treatments. But if you’re Black, doctors are less likely to propose a heart transplant, especially older doctors.
Research shows your chances of better health outcomes rise when you identify with and trust the person treating you. “It sure does help when culturally you can identify [with your provider] — if you have similar lived experiences or come from similar backgrounds,” McCants says. “As health care systems and providers, we ought to mirror the communities that we serve.”
“I think that will do a lot to reduce communication problems between physicians and patients,” Cheung says.
Unfortunately, it may not always be possible for Black and Hispanic people to visit a cardiologist who looks like them. Underrepresented minorities make up less than 8% of cardiologists in the U.S.
Representation in clinical trials
Researchers carry out clinical trials to learn if a new or existing medical treatment works or has any harmful side effects. These studies rely on volunteers to test therapies and treatments. The results determine which medications and other treatments doctors will prescribe to all their patients.
But the study participants aren’t always a good representation of all patients. There are often far more white people in these studies than Black or Hispanic people. Sometimes, the study results don’t even report the races or ethnicities of the study participants. In those cases, doctors have no way of knowing whether the treatments work equally well for people of all racial and ethnic backgrounds.
Blacks and Hispanics have long lacked representation in clinical trials for heart failure therapies. This is despite having higher rates of the disease. Clinical trials that include more racial and ethnic minorities “give us great insight into the impact of therapies on our patients,” Cheung says. “And not just some patients, but all of our patients.”
In late 2022, the U.S. Congress passed legislation that calls for more diversity in clinical trials. It requires drug sponsors to submit a diversity action plan to the FDA. The plan must include the sponsor’s enrollment goals and how they plan to meet them. This could begin to pave the way toward research discoveries that apply to people of all colors and not just some.
