Racial and ethnic disparities in coronary, vascular, structural, and congenital heart disease

Abstract

Cardiovascular disease (CVD) remains the leading cause of death in the United States. However, percutaneous interventional cardiovascular therapies are often underutilized in Blacks, Hispanics, and women and may contribute to excess morbidity and mortality in these vulnerable populations. The Society for Cardiovascular Angiography and Interventions (SCAI) is committed to reducing racial, ethnic, and sex‐based treatment disparities in interventional cardiology patients. Accordingly, each of the SCAI Clinical Interest Councils (coronary, peripheral, structural, and congenital heart disease [CHD]) participated in the development of this whitepaper addressing disparities in diagnosis, treatment, and outcomes in underserved populations. The councils were charged with summarizing the available data on prevalence, treatment, and outcomes and elucidating potential reasons for any disparities. Given the huge changes in racial and ethnic composition by age in the United States (Figure 1), it was difficult to determine disparities in rates of diagnosis and we expected to find some racial differences in prevalence of disease. For example, since the average age of patients undergoing transcatheter aortic valve replacement (TAVR) is 80 years, one may expect 80% of TAVR patients to be non‐Hispanic White. Conversely, only 50% of congenital heart interventions would be expected to be performed in non‐Hispanic Whites. Finally, we identified opportunities for SCAI to advance clinical care and equity for our patients, regardless of sex, ethnicity, or race.

Coronary orbital atherectomy treatment of Hispanic and Latino patients: A real‐world comparative analysis

“…Despite the higher cardiovascular risk for mortality in the HL population compared with whites, especially in those with severe CAC, 1,2 the outcomes in this OA analysis showed no difference between HL and non‐HL patients. Percutaneous interventional cardiovascular therapies are often underutilized in Hispanics and that may contribute to excess morbidity and mortality in this vulnerable population 9,10 . Overall, HL patients are more likely to present with comorbidities, experience longer delays before treatment, and suffer worse outcomes when compared with non‐HL white patients 10,11 .…”

Calcific Aortic Stenosis—A Review on Acquired Mechanisms of the Disease and Treatments

“…The TAVR utilization among underserved and underrepresented populations are lower. This was initially thought to be related to lower incident of AS among Black and Hispanic populations ( 109), but further studies suggested that this might be due to limited accesses to care, low socioeconomic status, and treatment biases in the non-White population (109)(110)(111)(112). This calls the need for advance clinical care accessible to all patients regardless of their race and ethnicity.…”

Racism and Cardiology: A Global Call to Action

“…During the early era of reperfusion in the USA, door-to-needle (thrombolytic therapy) and door-to-balloon times were significantly longer in Blacks compared to Hispanics or Whites 42 . More recent studies reveal that Black patients with ACS have longer wait times in the emergency department 43 and experience delays in coronary angiography and preferential use of bare metal vs drug-eluting stents 44,45 .…”

“…42 More recent studies reveal that Black patients with ACS have longer wait times in the emergency department 43 and experience delays in coronary angiography and preferential use of bare metal vs drug-eluting stents. 44 , 45 …”