Friday, March 20, 2009

DCRI cardiologist stresses value of genomics, other factors to eliminating health disparities
By Maggie De Pano, DCRI Communications

DCRI cardiologist Eric Peterson MD, MPH stressed the importance of genomics, access to care, disease management, and performance measurements to eliminating racial disparities in healthcare. Peterson's comments accompanied a University of California at San Francisco study, which showed that African Americans under 30 develop heart failure at a rate 20 times higher than Caucasians do.

Both articles were published March 19 in The New England Journal of Medicine.

Several studies have already described African Americans’ delayed or limited access to new technologies, costly invasive procedures, and treatments designed to control risk factors for heart disease. However, the UCSF study showed that risk factors such as high blood pressure more often preceded heart failure in blacks, offering evidence that health disparities are associated with adverse clinical outcomes.

Peterson wrote that putting race and genetics into perspective may help overcome these disparities. Studies have shown that a person’s race can affect how he or she responds to therapy. However, future genomic work will likely yield a more complete characterization of genetic differences which, in combination with social, environmental, and other factors, can lead to personalized, more effective treatments.

Peterson also called for improved access to healthcare strategies designed to prevent the development of risk factors or control risk factors that already exist. The UCSF study raised the possibility that a proactive approach to diet, lifestyle, and weight management might prevent high blood pressure. Peterson added that more complete control of high blood pressure when it’s already present should also reduce racial disparities in heart failure incidence.

Meanwhile, better patient education, better tools for patient engagement, and increased provider awareness of population-specific barriers to care (e.g. religious beliefs, cultural beliefs) might help address the problem that even when different racial and ethnic groups have similar access to care, blacks are still less likely to achieve target levels of risk factor control, said Peterson.

Lastly, performance-measurement and quality-improvement efforts should be explored. Research shows that caregivers respond to constructive feedback regarding quality of care, and adding public reporting and pay-for-performance initiatives might enhance their effect. Peterson noted that centers which participate in the American Heart Association’s Get with the Guidelines program routinely achieve greater than 90 percent adherence to core measurements for coronary artery disease, stroke, and heart failure in all patients regardless of race or ethnic background.