Addressing Disparity of Care

Organizations including the Institute of Medicine reported that racial disparities in healthcare exist often from implicit and unconscious biases. HRS believes it is important to bring awareness to the disparity of care in healthcare and reduce it through increased engagement, education, and accountability. These actions and more will move the profession forward with more equitable healthcare and increased creativity and innovation.

How DEI Impacts Patient Care

A focus on Diversity, Equity, and Inclusion (DEI) efforts in EP can positively improve access to care for all patients. It also facilitates more comprehensive and culturally sensitive healthcare providers that ultimately leads to an increase in patient trust and a reduction of biases. By providing tools and resources to help address disparity of care we are advancing our mission to improve the care of all patients.

References regarding gaps in clinical EP care

Volgman AS, Merz CNB, Benjamin EJ, et al. Sex and race/ethnicity differences in atrial fibrillation. J Am Coll Cardiol 2019; 74:2812–2815.
Kiernan K, Dodge SE, Kwaku KF, Jackson LR, Zeitler EP. Racial and ethnic differences in implantable cardioverter-defibrillator patient selection, management, and outcomes. Heart Rhythm O2 2022; 3:807–816.
Thompson LE, Maddox TM, Lei L, et al. Sex differences in the use of oral anticoagulants for atrial fibrillation: a report from the National Cardiovascular Data Registry (NCDR) PINNACLE Registry. J Am Heart Assoc 2017;6: e005801.
Essien UR, Kim N, Hausmann LRM, et al. Disparities in anticoagulant therapy initiation for incident atrial fibrillation by race/ethnicity among patients in the Veterans Health Administration System. JAMA Network Open 2021;4: e2114234.
Reddy KP, Eberly LA, Halaby R, Racial, et al. Ethnic, and socioeconomic inequities in access to left atrial appendage occlusion. J Am Heart Assoc 2023; 12: e028032.
Eberly LA, Garg L, Yang L, et al. Racial/ethnic and socioeconomic disparities in management of incident paroxysmal atrial fibrillation. JAMA Network Open 2021; 4: e210247.
Bhave PD, Lu X, Girotra S, et al. Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation. Heart Rhythm 2015; 12:1406–1412.
Hernandez AF, Fonarow GC, Liang L, et al. Sex and racial differences in the use of implantable cardioverter-defibrillators among patients hospitalized with heart failure. JAMA 2007; 298:1525–1532.
Packer DL, Mark DB, Robb RA, et al. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA 2019; 321:1261–1274.
Bush D, Martin LW, Lerman R, Chandler M, Haywood LJ. NHLBI AFFIRM investigators, Atrial fibrillation among African Americans, Hispanics and Caucasians: clinical features and outcomes from the AFFIRM trial. J Natl Med Assoc 2006; 98:330–339.

Disparity of Care in Research

Addressing disparity of care in EP research is also critical to providing a comprehensive advancement in medical knowledge. Positive outcomes of focusing on disparity of care in research include more equitable patient care, stronger research validity, increased innovation, which lead to improved overall outcomes.

References regarding gaps in workforce/research and influence on patient care

Khan SU, Subramanian CR, Khan MZ, et al. Association of women authors with women enrollment in clinical trials of atrial fibrillation. J Am Heart Assoc 2022; 11: e024233.
Batnyam U, Chang D, Cheung JW, et al. Quantification of female and underrepresented minority applicants to clinical cardiac electrophysiology fellowship. JACC Clin Electrophysiol 2022; 8:915–917.
Howell SJ, Simpson T, Atkinson T, Pellegrini CN, Nazer B. Temporal and geographical trends in women operators of electrophysiology procedures in the United States. Heart Rhythm 2022; 19:807–811.
Havranek EP, Mujahid MS, Barr DA, et al. Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association. Circulation 2015; 132:873–898.
Green AK, Trivedi N, Hsu JJ, Yu NL, Bach PB, Chimonas S. Despite the FDA's five-year plan, black patients remain inadequately represented in clinical trials for drugs. Health Aff (Millwood) 2022; 41:368–374.

References with solutions/ideas to address disparity of care

National Institutes of Health. NIH policy and guidelines on the inclusion of women and minorities as subjects in clinical research
Clark LT, Watkins L, Pina IL, et al. Increasing diversity in clinical trials: overcoming critical barriers. Curr Prob Cardiol 2019; 44:148–172.
Nguyen T, Wallerstein N, Das R, et al. In: Conducting community-based participatory research with minority communities to reduce health disparities. Hoboken, NJ: The Science of Health Disparities Research; 2021. 171–186.
Alsan M, Garrick O, Graziani G. Does diversity matter for health? Experimental evidence from Oakland. Am Econ Rev 2019; 109:4071–4111.
Greenwood BN, Carnahan S, Huang L. Patient-physician gender concordance and increased mortality among female heart attack patients. Proc Natl Acad Sci U S A 2018; 115:8569.
Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha A, et al. Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Intern Med 2017; 177:206–213.
Tamirisa KP, Al-Khatib SM, Mohanty S, et al. Racial and ethnic differences in the management of atrial fibrillation. CJC Open 2021;3: S137–S148.
Santhosh L, Babik JM. Trends in Racial and Ethnic Diversity in Internal Medicine Subspecialty Fellowships From 2006 to 2018. JAMA Netw Open. 2020. Feb 5;3(2):e1920482. doi: 10.1001/jamanetworkopen.2019.20482.

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