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Lopez JL, Duarte G, Taylor CN, Ibrahim NE. Achieving Health Equity in the Care of Patients with Heart Failure. Curr Cardiol Rep 2023; 25:1769-1781. [PMID: 37975970 DOI: 10.1007/s11886-023-01994-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW To discuss the prevailing racial and ethnic disparities in heart failure (HF) care by identifying barriers to equitable care and proposing solutions for achieving equitable outcomes. RECENT FINDINGS Throughout the entire spectrum of HF care, from prevention to implementation of guideline-directed medical therapy and advanced interventions, racial and ethnic disparities exist. Factors such as differential distribution of risk factors, poor access to care, inadequate representation in clinical trials, and discrimination from healthcare clinicians, among others, contribute to these disparities. Recent data suggests that despite improvements, disparities prevail in several aspects of HF care, hindering our progress towards equity in HF care. This review highlights the urgent need to address racial and ethnic disparities in HF care, emphasizing the importance of a multifaceted approach involving policy changes, quality improvement strategies, targeted interventions, and intentional community engagement. Our proposed framework was derived from existing research and emphasizes integrating equity into routine quality improvement efforts, tailoring interventions to specific populations, and advocating for policy transformation. By acknowledging these disparities, implementing evidence-based strategies, and fostering collaborative efforts, the HF community can strive to reduce disparities and achieve equity in HF care.
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Affiliation(s)
- Jose L Lopez
- Division of Cardiovascular Disease, JFK Hospital, University of Miami Miller School of Medicine, Atlantis, FL, USA
| | - Gustavo Duarte
- Division of Cardiology, Cleveland Clinic Florida, Weston, FL, USA
| | - Christy N Taylor
- Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York City, NY, USA
| | - Nasrien E Ibrahim
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA.
- The Equity in Heart Transplant Project, Inc, Boston, MA, USA.
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Chen Y, Kruahong S, Elias S, Turkson-Ocran RA, Commodore-Mensah Y, Koirala B, Himmelfarb CRD. Racial Disparities in Shared Decision-Making and the Use of mHealth Technology Among Adults With Hypertension in the 2017-2020 Health Information National Trends Survey: Cross-Sectional Study in the United States. J Med Internet Res 2023; 25:e47566. [PMID: 37703088 PMCID: PMC10534288 DOI: 10.2196/47566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) technology has the potential to support shared decision-making (SDM) and improve hypertension control. However, our understanding of the variations in individuals' involvement in SDM and mHealth usage across different racial and ethnic groups in the United States is still limited. OBJECTIVE This study aimed to investigate the extent of involvement in SDM and the usage of mHealth technology in health-related activities among US adults with hypertension from diverse racial and ethnic backgrounds and to examine whether the mHealth usage differed by individuals' level of engagement in SDM. METHODS This study used cross-sectional data from the 2017 to 2020 Health Information National Trends Survey, which was conducted on US adults with self-reported hypertension, and race and ethnicity data were included. The exposure of interest was race and ethnicity. The outcomes were SDM and mHealth usage. SDM was assessed using an item: "In the past 12 months, how often did your health professional: involve you in decisions about your healthcare as much as you wanted?" mHealth usage was defined as using a smartphone or tablet to engage in (1) making health decisions, (2) discussing health decisions with health providers, (3) tracking health progress, and (4) sharing health information. Weighted multivariable logistic regression models were used to examine the association between race and ethnicity and SDM or mHealth usage adjusted for covariates and stratified by the level of engagement in SDM. RESULTS This study included 4893 adults with hypertension, and the mean age was 61 (SD 13) years. The sample was 53% female, 61% (n=3006) non-Hispanic White, 19% (n=907) non-Hispanic Black or African American, 12% (n=605) Hispanic, 4% (n=193) non-Hispanic Asian, and 4% (n=182) non-Hispanic other. Compared to the non-Hispanic White adults, non-Hispanic Black adults were more likely to use mHealth to make health decisions (adjusted odds ratio [aOR] 1.70, 95% CI 1.23-2.34), share health information (aOR 1.46, 95% CI 1.02-2.08), and discuss health decisions with health providers (aOR 1.38, 95% CI 1.02-1.87). Significant associations were observed specifically among those who were always involved in SDM. Asian adults were less likely to be involved in SDM (aOR 0.51, 95% CI 0.26-0.99) and were more likely to use mHealth to track progress on a health-related goal (aOR 2.07, 95% CI 1.28-3.34) than non-Hispanic White adults. Hispanic adults were less likely to use mHealth to share health information (aOR 0.47, 95% CI 0.33-0.67) and discuss health decisions with health providers (aOR 0.65, 95% CI 0.46-0.94) compared to non-Hispanic White adults. CONCLUSIONS This study observed racial and ethnic disparities in SDM and mHealth usage among US adults with hypertension. These findings emphasize the significance of comprehending the involvement of SDM and the usage of mHealth technology within racially and ethnically diverse populations.
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Affiliation(s)
- Yuling Chen
- Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Suratsawadee Kruahong
- Johns Hopkins School of Nursing, Baltimore, MD, United States
- Mahidol University Faculty of Nursing, Bangkok, Thailand
| | - Sabrina Elias
- Johns Hopkins School of Nursing, Baltimore, MD, United States
| | | | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Baltimore, MD, United States
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Binu Koirala
- Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Cheryl R Dennison Himmelfarb
- Johns Hopkins School of Nursing, Baltimore, MD, United States
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Johns Hopkins School of Medicine, Baltimore, MD, United States
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Lauffenburger JC, Barlev RA, Khatib R, Glowacki N, Siddiqi A, Everett ME, Albert MA, Keller PA, Samal L, Hanken K, Sears ES, Haff N, Choudhry NK. Clinicians' and Patients' Perspectives on Hypertension Care in a Racially and Ethnically Diverse Population in Primary Care. JAMA Netw Open 2023; 6:e230977. [PMID: 36853607 PMCID: PMC9975920 DOI: 10.1001/jamanetworkopen.2023.0977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
IMPORTANCE Hypertension control remains suboptimal, particularly for Black and Hispanic or Latino patients. A need exists to improve hypertension management and design effective strategies to efficiently improve the quality of care in primary care, especially for these at-risk populations. Few studies have specifically explored perspectives on blood pressure management by primary care providers (PCPs) and patients. OBJECTIVE To examine clinician and patient perspectives on barriers and facilitators to hypertension control within a racially and ethnically diverse health care system. DESIGN, SETTING, AND PARTICIPANTS This qualitative study was conducted in a large urban US health care system from October 1, 2020, to March 31, 2021, among patients with a diagnosis of hypertension from a racially and ethnically diverse population, for a range of hypertension medication use hypertension control, as well as practicing PCPs. Analysis was conducted between June 2021 and February 2022 using immersion-crystallization methods. MAIN OUTCOMES AND MEASURES Perspectives on managing blood pressure, including medication adherence and lifestyle, considerations for intensification, and experiences and gaps in using health information technology tools for hypertension, were explored using semistructured qualitative interviews. These cycles of review were continued until all data were examined and meaningful patterns were identified. RESULTS Interviews were conducted with 30 participants: 15 patients (mean [SD] age, 58.6 [16.2] years; 10 women [67%] and 9 Black patients [60%]) and 15 clinicians (14 PCPs and 1 medical assistant; 8 women [53%]). Eleven patients (73%) had suboptimally controlled blood pressure. Participants reported a wide range of experiences with hypertension care, even within the same clinics and health care system. Five themes relevant to managing hypertension for racially and ethnically diverse patient populations in primary care were identified: (1) difficulty with self-management activities, especially lifestyle modifications; (2) hesitancy intensifying medications by both clinicians and patients; (3) varying the timing and follow-up after changes in medication; (4) variation in blood pressure self-monitoring recommendations and uptake; and (5) limited specific functionality of current health information technology tools. CONCLUSIONS AND RELEVANCE In this qualitative study of the views of PCPs and patients on hypertension control, the participants felt that more focus should be placed on lifestyle modifications than medications for hypertension, particularly for patients from racial and ethnic minority groups. Participants also expressed concerns about the existing functionality of health information technology tools to support increasingly asynchronous hypertension care. More intentional ways of supporting treatment intensification, self-care, and follow-up care are needed to improve hypertension management for racially and ethnically diverse populations in primary care.
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Affiliation(s)
- Julie C. Lauffenburger
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Renee A. Barlev
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- now at Vytalize Health, Hoboken, New Jersey
| | - Rasha Khatib
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, Illinois
| | - Nicole Glowacki
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, Illinois
| | - Alvia Siddiqi
- Enterprise Population Health, Advocate Aurora Health, Downers Grove, Illinois
| | | | - Michelle A. Albert
- Center for the Study of Adversity and Cardiovascular Disease (NURTURE Center), Division of Cardiology of Medicine (Cardiology), University of California, San Francisco, San Francisco
| | - Punam A. Keller
- Tuck School of Business, Dartmouth College, Hanover, New Hampshire
| | - Lipika Samal
- Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kaitlin Hanken
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ellen S. Sears
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nancy Haff
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Niteesh K. Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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