Because February is American Heart Month, we want to increase awareness of and assess the risk of heart disease in various communities. Although we now understand many of the underlying causes of heart disease, we still struggle to address those groups who are most affected. In fact, heart disease is a condition that is deeply rooted in bias and institutional racism for People of Color, and the study results are hard to digest:
- Black patients are 30 percent more likely to die from heart disease, twice as likely to have a stroke, and have higher rates of both heart failure and death from acute coronary syndrome. The most common early warning sign of heart disease in Black patients is high blood pressure.
- Asian Americans and Pacific Islanders report receiving low-quality care and are less likely to have access to preventive care. This includes blood pressure monitoring, blood tests, and other means of assessing early symptoms of heart disease.
- American Indians and Alaska natives die from heart disease at earlier ages. According to the American Heart Association, 36 percent of individuals identifying as Native American or an Alaska native died of heart disease before age 65. By comparison, only 17 percent of the total U.S. population will die before that age.
- Non-Hispanic Black and Mexican Americans have higher rates of obesity and are at much higher risks for diabetes than non-Hispanic White patients. Over time, these conditions can result in heart disease.
A study from the Centers for Disease Control and Prevention (CDC) indicates that while deaths among minority populations from heart disease has steadily decreased from 1999 to 2017, the rate at which the deaths are decreasing has remained stagnant over the past few years. Healthcare professionals believe this is attributed to multiple factors including racial disparities and access to care.
Racial disparities impact the entire healthcare system. According to a study, if health disparities and inequalities were eliminated, the U.S. would save more than $1.29 trillion in healthcare costs. Racial disparities can cause irreparable harm and force additional burden on patients. In fact, as much as 30.6 percent of excess direct medical care expenditures for Black, Asian, and Hispanic patients were due to complications caused by health inequalities.
How Primary Care Physicians Can Help
Primary care physicians are in an excellent position to intervene when early warning signs are present and can help patients understand their risk of cardiovascular disease.
Understanding the Social Determinants of Health
Assuring that members of all racial and ethnic groups receive high-quality care is a complex task, but physicians who are aware of the social determinants of health care better prepared to understand the struggles a patient may be facing when it comes to keeping up with their care. In fact, social determinants can influence up to 90 percent of health outcomes.
- Studies show that people of color are less likely to have:
- Health insurance
- Access to preventive care
- A designated primary care physician who knows their specific health needs or speaks their native language
- Socioeconomic disparities in their communities that lead to low-quality care
- Higher hospitalization rates
By understanding these factors, physicians may be able to help address the gaps. For example, by researching the resources available in their local communities, physicians may be able to recommend low-cost resources to help patients who do not have access to health insurance. One excellent resource for this research is 211, where physicians and patients can enter their zip code to learn more about available resources in their communities.
Bilingual staff can support patients who aren’t proficient English speakers. Long-term care management may be appropriate for patients who have limited access to preventive care. While care management cannot replace seeing a doctor, it may help reduce the likelihood that a patient will need hospitalization or have to go to the emergency room. Patients who do not have access to preventive care may benefit from more information about social programs like Medicaid.
Remember that the findings related to social determinants of health are high-level factors based on long-term studies. The best way for physicians to truly understand what challenges their patients are facing when it comes to their heart health and health goals is to ask.
Recognizing Implicit Bias
Everyone has implicit bias, but such bias can result in devastating impacts on a patient’s health. This is especially true when it comes to heart health. Studies typically define implicit bias as “thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control,” and that healthcare professionals exhibit low to moderate levels of implicit bias to patients of color.
Physicians may ask themselves, “How can I control something that is outside of my awareness?” Implicit bias comes from within, but it has various physical expressions, such as:
- Speaking to a patient of color in a condescending or dominant tone;
- Assuming anything about the patient of color, such as how they will comply with their treatment plan, and tailoring treatment based on these assumptions;
- Allowing special privileges to patients of various ethnicities, such as taking White patients first although the patient of color was on time for their appointment and has been in the waiting room longer; or
- Acting noticeably friendlier to a patient of one ethnicity over another
While acknowledging our own biases is critical to making changes, it is not enough. Physicians and healthcare professionals must actively reject bias in their practices. Annual or bi-annual diversity training and promoting an inclusive workplace culture can help.
Sometimes, recognizing implicit bias also involves understanding how a physician’s own appearance may affect others. The American Heart Association (AHA) found that patients do not feel as comfortable discussing their health or personal history with physicians and healthcare providers who are of a different ethnicity.
In addition to understanding the social determinants of health and recognizing implicit bias, upgrading a practice’s technology can help physicians identify and resolve any care gaps in heart health. Various electronic health records (EHRs) contain reporting tools that physicians can use to track their patients’ test results over time and look for gaps.
Upgrading a practice’s technology can be difficult, but partnering with a managed services organization (MSO) can drastically improve a physician’s administrative, technological, and logistical burdens. With a partner, physicians do not have to personally navigate the internal and external challenges of the healthcare landscape.
Physicians searching for ways their practice can immediately address these challenges should look at the AHA’s Get With the Guidelines® – Heart Failure program, which provides evidence-based approaches and guidance physicians can use to monitor their patients’ heart health and reduce the risk of readmission to the hospital.
Privia Women’s Health is a proud sponsor of the AHA’s Go Red for Women, an initiative to increase awareness for women’s heart health!
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