ECG’s radio show and podcast, Healthcare Upside/Down, offers unfiltered perspectives on what’s working in US healthcare and what’s not. Hosted by ECG principal Dr. Nick van Terheyden, each episode features guest panelists who explore the upsides and downsides of healthcare in the US—and how to make the system work for everyone.
As part of our series supporting American Heart Month, this episode explores inequities found in cardiovascular disease diagnosis and treatment and how we can deliver the best care to our entire population.
The progress in cardiology has been incredible. The most visible innovation for most people is the stethoscope, developed in the early 1800s to allow a doctor to listen to the heart without having to press their ear to a patient’s chest. Early versions of the electrocardiogram arrived later in the 19th century.
Over time, the medical profession noticed the rising incidence of deaths attributed to heart disease, which led to the launch of the now legendary Framingham Study in 1948—the insights from which continue to inform our understanding of the causes of cardiovascular disease. We saw the first heart transplant take place in 1967, and we have only added to our knowledge of cardiovascular disease care since then, with groundbreaking technology and new therapies.
But like many parts of our medical infrastructure, much of this research was built on data from white males. “In cardiovascular research studies, maybe 25% to 30% participants are women, maybe 5% or less are African American, and often 1% to 3% are Hispanic,” explains Wayne Batchelor, MD, an interventional cardiologist. “So we’ve got a long way to go.”
Dr. Batchelor is the director of interventional cardiology at Inova Heart and Vascular Institute. On episode 62 of Healthcare Upside/Down, he describes inequities in research, diagnosis, and treatment in cardiovascular care and the steps we can take to make care more widespread and equitable. Below are a few excerpts.
The need for diversity in research.
“Research is pivotal. It’s the way we garner our estimates on the safety and the effectiveness of new devices and pharmaceutical agents. The challenge is that research has been skewed in terms of the population of patients enrolled in research trials—the vast majority of participants in cardiovascular trials have been white men, with women less represented and minorities poorly represented. We’re getting more diverse as a country, and part of our responsibility is to ensure that the devices and drugs that we release have been vetted and tested in the patients in whom they will be used.”
Dispelling myths about modern clinical research.
“The number one thing that is crucial to moving forward is educating our populace on what clinical research is. The first thing that comes to mind for a lot of minority patients is fear and mistrust. We’ve got to break those barriers down. We’ve got to rebuild trust in all segments of society with regard to research. I wish our research IQ as a nation was better. Many people think [clinical research is] this guinea pig approach where you’re going to be experimented on. Some historical atrocities still ring in true in people’s minds.”
“[Research is] heavily regulated. There are extremely high moral and ethical standards for performing research; we’ve got to make sure people understand that, and that research participation is a wonderful thing you can do that’s altruistic. And in some cases, it’s a way you can access novel therapies with unique solutions that [are not available] outside of a clinical trial. So there’s a lot of work to be done.”
Technological advances in cardiovascular care.
“I couldn’t be more excited as an interventional cardiologist. The valve therapies we’re offering are getting more safe, more effective, and less invasive. We’re able to treat more patients, and they’re able to recover quicker, live longer, and live better. It’s just been absolutely amazing what’s happened in the last decade. I think artificial intelligence is going to factor into this tremendously. Technological advances are going to work in our favor. The question is, how are we going to use it in a manner that will break down some of these barriers and get rid of some of these rampant disparities?”
On the podcast, Dr. Batchelor talks more about emerging medical technology, its potential to improve early detection of cardiovascular disease, and the need to double down on educating patients.
Edited by: Matt Maslin
Published February 13, 2023