Recent studies conducted by Duke researchers show significant gender and racial differences in heart disease treatment, reinforcing the argument for increased cultural awareness and changes in treatment practices.
Two studies, which were presented at the American Heart Association news conference in New Orleans last November, indicate that minorities and women undergo fewer procedures to treat severe cardiac failure. Researchers are continuing studies to identify the exact sources of this disparity.
The first study, conducted by Associate Professor of Cardiology Dr. Judy Battle, looked at 64,936 cases of Medicare patients with life-threatening heart rhythm abnormalities.
Researchers found that black patients received implantable cardioverter-defibrillator devices at one-third the rate that whites received them, while white women received less than half the number of white males. Implantable defibrillators have been clinically shown to be superior to existing medical treatments for severe cardiac rhythmic abnormalities.
"These racial disparities are indicative of a need to bridge gaps [between races and genders]," Battle said. "It is inappropriate when there is a known better treatment but certain races are not receiving it. These findings follow past trends which also suggest a marked disparity in treatment of blacks and women for previously documented common [heart] procedures."
A second study suggests that black patients have less access and responses to treatment for diastolic heart failure. Diastolic heart failure, which is the leading cause of hospital readmission, is a precursor to complete heart failure.
The same study, conducted by lead researcher Dr. Mark East, also reports that black patients have higher mortality rates than white patients, are at greater risk from conditions such as hypertension and diabetes and are 30 percent more likely to die from heart failure than their white counterparts, even after controls for clinical conditions have been made.
The 3,303-patient pool that East included in his clinical trial makes this the first-ever group study of diastolic heart failure.
While this research will be used to enhance what is known about treating diastolic heart failure, East believes it will also mandate efforts to include more minorities in future clinical trials in order to understand the effectiveness of treatment in different groups of people.
Although neither study was intended to determine the underlying causes of these disparities, both Battle and East are continuing their research.
"I think genetically there is very little difference between blacks and whites but these disparities have to do primarily with access to care," East said. "Two people may have the same level of disease but they won't necessarily receive the same level of care."
Battle, who plans to examine her results by geographical locations in the future, believes these differences are caused by a combination of factors, such as patient preferences, physician bias, geography and socio-economic status.
"If anything, [research on procedures] will show that patient-physician interactions need to be improved if there are misunderstandings," said East, a co-researcher in Battle's study. "These gaps in communication need to be bridged and a cultural understanding and sensitivity needs to be adopted by all physicians."
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