Disparities in Echocardiography and Solutions for Heart Health Care
By Gina Michiko Craig
When patients visit their primary healthcare provider for checkups, the heart may be one of the first organs checked for unusual behavior. This critical organ in our body function may need additional diagnostic testing sometimes. At some of these times, a diagnostic heart imaging test called an echocardiogram may be needed to check heart function and structure. But what kind of diagnostic testing disparities in race, age, and sex are patients up against for obtaining echocardiograms in the U.S., and how can heart health outcomes be overcome?
Disparities in Diagnostic Testing With Echocardiograms
Researchers at Beth Israel Deaconess Medical Center wondered about the disparity issue and conducted a study that found the patient characteristics of being Black, female, or older decreased rates of receiving echocardiograms as part of healthcare. Even after adjusting for the relative health of patients, the echocardiogram disparities of lower testing rates for non-whites, females, and older patients were revealed in the study data. And in looking at diagnostic echocardiograms for Black men versus Black women, Black women were less likely to receive echocardiograms in comparison to Black men. Dr. Jordan Strohm, director of echocardiographic research in the Division of Cardiovascular Medicine at BIDMC, and assistant professor of medicine at Harvard Medical School discussed the study. "Our study suggests the existence of significant age, racial and sex disparities in the receipt of echocardiograms. Identifying these disparities represents the first step towards addressing them."
Positive Impact of Care at Academic Medical Centers
The research data picture with heart health care at academic medical centers shows a different picture. With heart health outcomes in mind, researchers at the Barbara Streisand Women’s Heart Center at Smidt Heart Institute at Cedars-Sinai examined patient data in a multi-year and multi-center study. The study researchers looked at data for a cohort of women with obstructive coronary artery disease treated at academic medical centers, and they found that racial and ethnic disparities had no impact on long-term health outcomes. Medical background information about the group included a comparison to non-Black women and showed that Black women had higher rates of cardiovascular risk factors, such as obesity and hypertension; lower levels of education; lower income levels; and a higher proportion of public health insurance.
The study researchers were encouraged by their findings by the excellent care given at academic research centers. Dr. Janet Wei, associate medical director of the Biomedical Imaging Research Institute and co-director of the Stress Echocardiography Lab in the Smidt Heart Institute, stated, “Our findings suggest that when women with coronary artery disease are treated in an academic setting—as were the women involved in the WISE study—they may experience less racial and ethnic discrimination and receive appropriate guideline-directed therapy.” As awareness about the findings from the Barbara Streisand Women’s Heart Center increases, perhaps more patients will have an interest in seeking support to overcome care access at academic medical centers. Patient navigators can help patients with locating transportation, language translation support, and other ways to access academic medical center experts.
Though there are disparities in the use of the diagnostic test of echocardiograms for patients who are Black, female, or older, the data of heart health care at academic medical centers is encouraging. Patients and patient advocates can help raise awareness for improved heart health care and diagnostic imaging.
What can you do next?
Advocate for yourself and others. Be sure to share your concerns and opinions. Write to your congressperson to ask for federal funding to support diverse representation in diagnostic testing with echocardiograms.
Build community and support toward equity in diagnostic testing. Look for online forums discussing equity in diagnostics for heart health for all. Ask your healthcare provider for other ways to find people working to close the gap in heart health diagnostic testing disparities.
Lead. If you are a healthcare provider, examine how you currently engage with your patients. Consider joining our Pro Hub to connect with other experts committed to removing barriers to health equity.
Sources
Racial and Ethnic Disparities Evaluated in Heart Disease. Cedars-Sinai website. Accessed August 30, 2024. https://www.cedars-sinai.org/newsroom/racial-and-ethnic-disparities-evaluated-in-heart-disease/
Terri Janos. Researchers Find Race, Sex and Age Disparities in Echocardiography. Beth Israel Deaconess Medical Center website. Accessed August 30, 2024. https://www.bidmc.org/about-bidmc/news/2021/10/researchers-find-race-sex-age-disparities-echocardiography
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