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Cardiologists' Perspectives on Race-Based Drug Labels and Prescribing Within the Context of Treating Heart Failure
Shawneequa L Callier1,2, Brooke A Cunningham3, Jill Powell4
1Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Insights
Cardiologists acknowledge potential benefits of race-based heart failure treatments but also significant harms. Despite concerns, many continue to consider race when prescribing specific medications like BiDil.
Area of Science:
- Cardiology
- Pharmacology
- Medical Ethics
Background:
- Race is considered in heart failure treatment, particularly with specific drug labels.
- Cardiologists' views on race-based prescribing benefits and harms are not well-documented.
Purpose of the Study:
- To explore cardiologists' perspectives on the benefits and harms of race-based drug labels and guidelines.
- To assess attitudes toward using race in prescribing isosorbide dinitrate and hydralazine hydrochloride (BiDil).
Main Methods:
- 81 semistructured interviews conducted with cardiologists and cardiology fellows.
- Inductive qualitative analysis used to review and code interview data.
Main Results:
- Many cardiologists believe race-based labels could expedite effective medication prescription.
- Over half expressed concerns about potential patient harm, including drug access and simplistic race application.
- Identified harms include lack of understanding of gene-drug-environment interactions.
Conclusions:
- Few cardiologists approve race-based prescribing without acknowledging potential harms.
- Most continue to consider race for specific heart failure medications.
- Further discussion on the benefits and harms of race-based prescribing is needed.
Abstract:
Purpose: Cardiologists are known to consider patients' race when treating heart failure, but their views on the benefits and harms of this practice are largely undocumented. We set out to explore cardiologists' perspectives on the benefits and harms of race-based drug labels and guidelines. Specifically, we focused on isosorbide dinitrate and hydralazine hydrochloride (sold in a patented form as BiDil), a combination of drugs recommended for the treatment of black patients receiving optimal medical therapy for symptomatic heart failure and reduced ejection fraction. Methods: We conducted 81 semistructured interviews at an American College of Cardiology Annual meeting to assess cardiologists' and cardiology fellows' attitudes toward the use of race in drug prescribing. Investigators reviewed and coded the interviews using inductive qualitative analysis techniques. Results: Many participants believed that race-based drug labels might help doctors prescribe effective medications to patients sooner. More than half of the participants expressed concerns, however, that considering race within the context of treating heart failure could potentially harm patients as well. Harms identified included the likelihood that patients who could benefit from a drug may not receive it because of their race; insufficient understanding about gene-drug-environment interactions; and simplistic applications of race in the clinic. Conclusions: Few participants expressed approval of using race in drug prescribing without recognizing the potential harms, yet most participants stated that they continue to consider race when prescribing isosorbide dinitrate and hydralazine hydrochloride. Within the context of treating heart failure, more open discussions about the benefits and harms of race-based drug labels and prescribing are needed to address cardiologists' concerns.