According to data from the Centers for Disease Control and Prevention and reports from US News, heart disease has long been the leading cause of death in the United States, accounting for almost one in every four fatalities each year. Like many other health problems, heart disease disproportionately affects specific demographic and socioeconomic groups, underlining the unfortunate adage that the ZIP code is a primary risk factor for poor health.
During a recent U.S. News webinar on “Taking a Population Health Approach to Combat Heart Disease,” Victor Bulto, head of U.S. Pharmaceuticals for Novartis Pharmaceuticals Corporation, said, “If significant changes are not made to curtail the rising incidence of cardiovascular disease, that burden is likely to overwhelm society,,,” especially among vulnerable populations. According to a study, more than 1 million Americans will die each year from cardiovascular disease by 2030. “That is an extremely compelling call to action.”
To help, all institutions must first establish what population health means to them before addressing the deficiencies in their systems, according to Dr. Sumeet Mitter, assistant professor of advanced heart failure and transplant cardiology at Mount Sinai Heart in New York. Then, he explained, therapists can “understand what interventions can genuinely affect an outcome and generate evidence-based guidelines to implement treatment programs.” Mitter stated the following, “How can we establish those programs to give care to people in their communities while also ensuring that they can work with professionals who understand their histories and cultural mores?” this is a vital question for everyone to ponder.
Dr. Stephen Klasko, a General Catalyst executive in residence who previously served as president and CEO of Thomas Jefferson University and Jefferson Health in Philadelphia, described a program at that institution aimed at reducing health inequities that focused on five Philadelphia ZIP codes with a 10- to 15-fold higher rate of cardiovascular disease. The initiative entailed developing a messaging campaign “similar to a political campaign” in local barbershops, residences, and other community locations so that residents might be taught where they live and work.
Novartis “soon realized our obligation goes far beyond” generating revolutionary medications, according to Bulto. “We can’t just design a treatment if it doesn’t target the group it’s supposed to serve because of a lack of education, medicine access, or affordability.”
Big Pharma can also help by developing more inclusive clinical trials, according to Bulto.
“Last year, we announced a 10-year partnership with 26 historically Black colleges, universities, and medical schools across the United States to precisely design programs that address the root causes of those systemic disparities and create greater diversity, equity, and inclusion across the entire research and development ecosystem,” he said. Faculty research grants and student fellowships are part of the program. “We hope that these elements will also contribute to bringing more diversity and equity to those treatments once we’ve established what the interventions can be in the different communities,” Bulto said, adding that by increasing diversity among clinical trial investigators and participants, “we hope that these elements will also contribute to bringing more diversity and equity to those treatments once we’ve established what the interventions can be in the different communities.”
The Institute for Health Equity Research at Mount Sinai has several equity-focused activities. Mitter discussed early lifestyle modification efforts and their influence on people’s health and the availability of language translation services. “We have to break down those communication hurdles to develop trust and get them into clinical trials so that our clinical trials genuinely reflect the variety of our patient community,” Mitter added.
It is also vital to increase diversity within the medical industry. Dr. Sharon Andrade-Bucknor, assistant professor of clinical medicine and associate program director of the cardiology fellowship program at the University of Miami School of Medicine, said, “A significant portion of the physician-patient connection is founded on trust.” According to studies, when the patient and the practitioner share the same racial background, the patient’s outcomes increase. “Of course, some of this is based on past sentiments of discrimination and prejudices that exist.”
More minorities in senior and leadership positions and promoting opportunities in the sector “would encourage more medical students to be interested in this profession,” Andrade-Bucknor added. “I believe that, in the end, this will improve the patients’ trust, communication, and compliance, as well as their cardiovascular disease outcomes.”
While the COVID-19 epidemic highlighted already-existing health disparities in the United States, it also caused many Americans to wait longer for treatment.
COVID, in turn, affects heart disease, according to Andrade-Bucknor. Even in those who have had only a minor or asymptomatic infection, the virus can cause cardiovascular problems. “How much of this will manifest down the road has to be seen,” she said.
Community interventions, on the other hand, can have a significant impact. Mitter cited a study published in The New England Journal of Medicine in 2018 that found that blood pressure treatments from pharmacists in Black barbershops resulted in a six-month reduction in blood pressure levels. “That’s wonderful,” he added, “and I believe that’s a terrific example of how we need to transfer care out of the center and engage with different community health care worker models.” It can’t be a doctor in a major hospital or a large clinic.”
If there’s one thing the pandemic has taught us, “we need much more radical collaboration,” Klasko said, “I think the one thing that has to happen when we start to think about these kinds of things is that we have to figure out a way for public health officials, physicians, cardiologists, and pharma to gather together within a state and across counties and come up with a uniform message.”
According to Andrade-Bucknor, combating inequality in all aspects of health care requires trust and communication. “That comes out of COVID, and I believe it can easily be extrapolated to heart disease and several other disorders,” she said. “Improving trust, communication, and compliance by having the correct diversity in communications.”