Community Investment, Engagement Are Essential to Fully Address Cardiovascular Health Disparities

Heart failure remains a serious complication, contributing to great rates of morbidity and mortality in affected patients. Persistent disparities in heart failure have reinforced the need to take a closer look at why some populations bear the brunt of disease burden more than others. Health inequities was a large topic explored throughout the 100th American Heart Association (AHA) conference. Khadijah Breathett, MD, MS, FACC, associate professor of medicine, Indiana University, spoke to the impact of social determinants of health and, notably, how community-based research can inform efforts to tackle inequities in cardiovascular disease.

This transcript has been lightly edited for clarity and length.

Transcript

What findings from community-based research have been the most surprising, specifically regarding factors that drive disparities in cardiovascular health?

I think there are multiple issues that have come to the horizon. One: we definitely need to include the community. In my own work, I've focused on developing a patient and stakeholder community advisory board that's national that we use to develop ideas, to understand what the problems are, to develop the strategies, using actually implementation science frameworks, to then attempt to deploy in studies to fix some of these major disparities that are facing our nation, particularly in the way that we deliver cardiovascular care.

I think there's a greater focus on that now, on community-based research, community-based participatory research as well. I think one of the major benefits that have happened over the past couple years is that some of the large funding organizations also recognize that this is important, and have made this a major requirement to compete for some of these large awards.

We have to include the community as we're moving forward to address these problems of disparities in cardiovascular disease. It's devastating underrepresented populations, and it's only projected to worsen over the next several decades.

Can you speak to the value of community engagement? What strategies have you found are the most effective for building trust and optimizing engagement within communities impacted by cardiovascular health disparities?

We know you have to belong to the community and invest in the community to develop those appropriate relationships and identify "what does the community need?" so that we can again work collaboratively together to meet those needs. And so for me, personally, it's really important just in terms of who I am to belong to my faith community, to my church, and so that's a natural community I already belong to. And I use those different communities to also work on the some of the research that I do. As I've lived in many different places over the past couple decades, I've developed relationships with individuals that also care about these things, with community members and also those may have an academic position as well to figure out, how can we do things differently, how can we think outside of the box of what is considered the status quo, to do things differently.

I had a study called the CEASe study that was actually funded through the HRSA [Health Resources and Services Administration] to identify how to improve cardiovascular care delivery in an inpatient setting. And we looked at population data nationwide, statewide, to understand what are the differences in care, particularly in regards to something called the segregation index, to understand the likelihood that a patient will receive care from a cardiologist, or whether they'll receive care from a group of people that vary based upon the race of the actual patient, and how does that impact their care. We've had a lot of complex findings. Some are still under review with respective journals, so I can't completely share all of what we found, but there were some interesting, significant findings that need to be addressed further.

And so we presented this data to our national patient stakeholder advisory board, and then discussed what were the next steps. And some of the next steps included actually directly observing patients and health care team members over the course of the day, watching what the interactions were like, and then performing interviews with these individuals to understand what they think are potential issues and what their views are on social determinants of health. And that work is actually also in development in a manuscript form, but one of my mentees actually presented that at the American College of Cardiology just earlier this year, and it's formed the basis for another large grant that we have under review to, again, work at addressing that focal cause of improving health care delivery, particularly to minoritized racial/ethnic groups and women.