New Quality Measure Seeks to Optimize Cardiovascular Care For African Americans
In recent months, the debate on race and policing in this country has ignited passions and raised important questions. But while headlines have highlighted instances of excessive force by police and the discriminatory treatment of African Americans, the conversation hasn't yet made the logical leap to a discussion around unequal access to care.
It is widely accepted in medical literature that African Americans, Hispanics, and the poor are receiving substandard health care. By way of example, the treatment of heart disease should not be a matter of race; it should be a matter of science and medicine. Today, there are thousands of African Americans living with heart failure (HF) [Footnote 1], and according to reputable studies, about 150,000 should be prescribed a drug regimen known as fixed-dose combination of hydralazine and isosorbide dinitrate (fixed-dose). However, of those African Americans who are clinically eligible for the therapy, very few are receiving it. And as a consequence, studies are finding that nearly 7,000 blacks die prematurely every year because they are receiving poor care [Footnote 2]. That is more lives lost than on that infamous day on September 11th and during hurricane Katrina combined; more deaths than those who lose their lives every year in encounters with police. The major difference is that these deaths are occurring outside of public view.
Neither skin color nor race explains the effectiveness of the fixed-dose. By happenstance, clinical research found race to be a useful "proxy" that could help them identify the responsible genetic marker as blacks with HF were clearly benefiting from the medication. Instead of waiting for the identification of the marker, the Federal Drug Administration made the decision to immediately approve the drug so as to save black lives.
So, reasonable people are left to ask: how can a scientifically-proven treatment that reduces mortality in a definable population be such an afterthought in our health care system? There is truly no good answer. Indeed, this is an unacceptable and indefensible outcome in an area that affects hundreds of thousands of Americans.
The National Quality Forum (NQF) -- an organization with significant influence on how physicians treat patients -- is currently considering a submission for a new quality measure that looks at whether African-Americans with HF are receiving the best standard of care. The proposed measure would promote awareness of appropriate treatment, help tout the benefits of such treatments to relevant parties, and strongly encourage health care providers to ensure that eligible African American patients are afforded every reasonable tool to combat cardiovascular disease, including cutting edge prescription drugs.
The benefits of the treatment have been published in the New England Journal of Medicine and other peer-reviewed sources and closely scrutinized by the scientific community and propagated by guidelines from the American College of Cardiology and American Heart Association. And the quality measure itself has earned the full support of the Association of Black Cardiologists and the Cardiometabolic Health Congress.
To be clear, a quality measure is not a miracle prescription. Environmental factors, socioeconomic conditions, and reducing behavioral risk are also critical to lowering mortality rates for African Americans suffering from heart disease. But the medical community has to be held accountable for ensuring equal access to proper care, and a quality measure is a good beginning.
Medicine cannot be a backwater where historic inequities in care are much discussed, where the statistics of lives cut short are duly recorded, but not a finger is lifted to address systemic problems. Black lives matter in our streets, in our hospitals, in our clinics, and in our physician's offices. Indeed, every American life matters, and deserves equal access to the treatment and care that science determines to be in their best interest.
[NMQF is the steward of the proposed cardiovascular quality measure]
1- Thom T, Haase N, Rosamond W, et al. Heart disease and stroke statistics--2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006:113;e85-e151.
2 - Gregg C. Fonarow, Clyde W. Yancy, Adrian F. Hernandez, Eric D. Peterson, John A. Spertus, and Paul A. Heidenreich, "Potential impact of optimal implementation of evidence-based heart failure therapies on mortality", American Heart Journal, June 2011, Volume 161, Number 6, pp. 1025-1026.