The Association of Black Cardiologists (ABC) Cardiovascular Implementation Study (CVIS): A Research Registry Integrating Social Determinants to Support Care for Underserved Patients

African Americans, other minorities and underserved populations are consistently under- represented in clinical trials. Such underrepresentation results in a gap in the evidence base, and health disparities. The ABC Cardiovascular Implementation Study (CVIS) is a comprehensive prospective cohort registry that integrates social determinants of health. ABC CVIS uses real world clinical practice data to address critical gaps in care by facilitating robust participation of African Americans and other minorities in clinical trials. ABC CVIS will include diverse patients from collaborating ABC member private practices, as well as patients from academic health centers and Federally Qualified Health Centers (FQHCs). This paper describes the rationale and design of the ABC CVIS Registry. The registry will: (1) prospectively collect socio-demographic, clinical and biospecimen data from enrolled adults, adolescents and children with prioritized cardiovascular diseases; (2) Evaluate the safety and clinical outcomes of new therapeutic agents, including post marketing surveillance and pharmacovigilance; (3) Support National Institutes of Health (NIH) and industry sponsored research; (4) Support Quality Measures standards from the Center for Medicare and Medicaid Services (CMS) and Commercial Health Plans. The registry will utilize novel data and technology tools to facilitate mobile health technology application programming interface (API) to health system or practice electronic health records (EHR). Long term, CVIS will become the most comprehensive patient registry for underserved diverse patients with cardiovascular disease (CVD) and co morbid conditions, providing real world data to address health disparities. At least 10,000 patients will be enrolled from 50 sites across the United States.

Abstract 107: Cardiovascular Risk Predictors Among Black and African American Women: A Preliminary Analysis of the P4 Study

Objective: To identify predictors that allow for early detection of cardiovascular disease in African American women

Background: Cardiovascular (CV) mortality is high in African Americans in the United States. Cardiovascular disease (CVD) remains the leading cause of death in African American females. We hypothesize that certain cardiovascular risk factors are predictors of abnormal peripheral vascular compliance. We aim to identify determinants of abnormal vascular compliance by assessing the association between known CVD risk factors and the extent of vascular compliance

Methods: This cross-sectional study utilized survey responses and results from a noninvasive screening tool. The study included only African American women. Traditional CV risk factors were independent variables (history of hypertension, high serum lipids, family or personal history of CVD). The instrument employed biomarkers that detect blood vessel elasticity. Outcome measures included small and large vessel compliance. Both survey responses and screening results were obtained from 70 consecutive participants. We conducted a univariate and bivariate descriptive analysis. A Chi-square or Fishers exact test was used to determine the significance as appropriate. We adjusted for potential confounders in our multivariable analysis. SAS 9.4 software was used for all the data analyses

Results: Our study indicates that personal history of cardiovascular disease is strongly associated with abnormal small vessel compliance (Pvalue - 0.01). Family history of cardiovascular disease is strongly associated with abnormal large artery compliance (Pvalue - 0.02). History of cardiovascular disease in both parents is associated with abnormal large artery compliance (Pvalue - 0.04). Interestingly, Living Situation (Living alone) was associated with abnormal large artery compliance (Pvalue - 0.03)

Conclusion: Family and personal history of CVD, and living alone have strong associations with abnormal vascular compliance. Cardiovascular mortality is high in Black and African American females. Identifying predictors of abnormal vascular compliance can allow for early disease detection and intervention.

The Community Physicians' Network (CPN): an academic-community partnership to eliminate healthcare disparities

INTRODUCTION

Disparities in health care are maintained by three primary factors: 1) patient factors which include multiple risk factors and comorbidities; 2) healthcare practitioner factors comprising inconsistent application of practice guidelines due to a limited database of clinical trials of effective therapies in African Americans and other underrepresented minorities; and 3) barriers in the healthcare delivery system resulting in poor access to care. The Morehouse School of Medicine Community Physicians' Network (CPN) was established to address disparities in health care by focusing on provider-specific strategies.

OBJECTIVES

To: 1) use disease-specific registries to identify treatment gaps and facilitate quality improvement processes among CPN practices; 2) develop practice-specific and guideline-based educational messages to promote quality care; 3) engage and train CPN-physicians for participation in approved NIH, other government, and industry-supported clinical protocols; and 4) develop a data repository of all CPN-sponsored clinical trials that include significant numbers of African Americans and other underrepresented minorities.

METHODS

The disease-specific outpatient registries will have the following features: 1) data structures and data elements will use standard database codes and a data dictionary; 2) HIPPA-compliant data abstraction and data transfer tool; 3) baseline chart review to establish practice patterns and provide practice-specific feedback; 4) annual update of registry; 5) data registry and repository maintained on Morehouse School of Medicine's secure servers; 6) registry publications will include only aggregate data, without identification of contributing practices; 7) an electronic medical records platform will be encouraged as the ultimate data management tool for CPN practices. In addition, up to three continuing medical education (CME) programs each year will feature national speakers and promote evidence-based practice guidelines.

RESULTS

Eighty-five primary care and subspecialty practices are actively enrolled in CPN with a total of 385,000 annual outpatient visits. The makeup of insurance status is: HMO/PPO (45%); Medicare only (19%); Medicare HMO (11%); Medicare plus (8%); Medicaid (6%); Uninsured (11%).

CONCLUSIONS

The Community Physicians' Network will address specific gaps in the health care of African-American and other minority patients by promoting quality care among its members and by facilitating participation in approved clinical trial protocols. The unique academic community partnership is consistent with the NIH roadmap goal of eliminating healthcare disparities.