Speaker: Interventional cardiologists must combat racism, disparities in care
Black patients are less likely than white patients to get interventional cardiology procedures even when similarly indicated, and action is required to end the practice, according to a speaker.
“We keep documenting the problem, and documenting the problem, and documenting the problem, but nothing is getting better,” Quinn Capers IV, MD, FACC, professor of medicine (cardiology) and associate dean for faculty diversity at the University of Texas Southwestern Medical Center, said during the Hildner Lecture at the virtual Society for Cardiovascular Angiography and Interventions Scientific Sessions.
Capers said research showing Black patients with certain conditions are less likely to get guideline-directed interventional procedures compared with white patients with the same conditions has been published consistently for more than 20 years.
Among patients with the same clinical characteristics, Black patients are less likely than white patients to receive or be counseled about an implantable cardioverter defibrillator, to be referred for timely cardiac catheterization, to receive revascularization instead of amputation for critical lower-extremity ischemia and to receive a transcatheter therapy for structural heart disease, Capers said.
“The best way to turn the corner from documenting the problem again and again and again to actually doing something about it is to come up with a list of culprits and then a list of action items,” he said.
He said the culprits for the problem include structural and individual racism; unconscious bias by physicians; Black patients being averse to procedures with new technology, often because of historical mistreatment; inadequate resources and treatments at hospitals predominantly used by Black patients; disparities in awareness of heart disease and treatments for it; and lack of diversity among interventional cardiologists.
Particularly troubling, he said, was that one study showed “70% of physicians have an unconscious preference for whites over Blacks and an unconscious association of Blacks with danger, fear, violence and misery.” He noted that prevalence extends to members of medical school admissions committees, which can impact who is allowed to become a doctor and attain a cardiology fellowship.
Action items to address these problems include participating in national quality improvement programs; conducting outreach to Black members of a community to promote procedures like transcatheter structural heart interventions; enhancing diversity in clinical trials and reevaluating the enrollment approach when there is not enough diversity; conduction of bias mitigation training; enhancing diversity in interventional cardiology fellowship training programs; and being an activist to combat bias and racism.
Institutions should have “an equity auditor who looks at [the CathPCI Registry] and says, ‘Listen, are the outcomes different for our Black vs. our white STEMI patients? If so, we need to have an investigation to see why this is the case,’” Capers said.
What may help is “the introduction of a new teaching tool to help confront bias and racism,” he said. “A [mortality and morbidity]-like conference quarterly where you gather your team and talk about racially insensitive comments made about patients or other racist incidents on the ward that can impact patient care. We talk about them in an educational manner, and about how to reduce them for the next quarter so that our patients can get excellent care.”
He concluded that “racial disparities exist in interventional cardiology and, admittedly, many of those things are out of our control. You often meet your patient on the cath lab table. That patient has overcome social determinants of health and the lack of access to a doctor who refers him for the right procedure. However, when things are in our control, disparities still exist. We can work together to end them.”
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Capers Q. Hildner Lecture. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; April 28-May 1, 2021 (virtual meeting).