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Achieving Health Equity by Normalizing Cardiac Care.

Cheryl Pegus1, Ian Duncan2, Judy Greener3

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African Americans receive fewer cardiac procedures like angioplasty despite similar heart disease rates. Addressing disparities in cardiac care access is crucial for health equity and reducing costs.

Keywords:
Medicareacute myocardial infarctionaortic stenosisintermediate coronary syndromepercutaneous transluminal coronary angioplastytranscatheter aortic valve replacement

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Area of Science:

  • Cardiology
  • Health Equity
  • Health Services Research

Background:

  • Minority patients, especially African Americans, undergo fewer cardiac procedures than white patients, even with comparable insurance.
  • Existing disparities in cardiac procedure rates persist despite similar disease prevalence.

Purpose of the Study:

  • To analyze disparities in cardiac procedure rates among different racial groups.
  • To investigate the rates of percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) and intermediate coronary syndrome (ICS), and transcatheter aortic valve replacement (TAVR) for aortic stenosis.

Main Methods:

  • Analysis of the 2012-2013 Medicare Limited Data Set (5% sample).
  • Comparison of PTCA and TAVR rates between African American and white patients.

Main Results:

  • African Americans have similar prevalence rates for AMI and ICS but significantly lower PTCA rates (10.57% vs. 19.40%, a 46% difference).
  • Lower procedure rates result in an estimated $90 million annual "lost" revenue within the Medicare population.

Conclusions:

  • Normalizing cardiac procedure rates for African Americans requires multi-stakeholder engagement, including patients, providers, and insurers.
  • Providing equitable, evidence-based care improves health outcomes, reduces high-cost conditions like heart failure, and aligns with value-based care models.