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Unlocking Diversity in Cardiovascular Clinical Research: Lessons from the Screening for Cardiac Amyloidosis With
Abdirahman Wardhere1, Dimitrios Bampatsias1, Elizabeth Cohn2
1Department of Cardiology, Cardiac Amyloidosis Program, Columbia University Irving Medical, New York City, NY.
Insights
Direct recruitment by care teams improved enrollment of eligible minority participants in a cardiac amyloidosis study. This approach, alongside higher education and English proficiency, boosted participation rates, aiding future clinical research diversity.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- The Screening for Cardiac Amyloidosis with Nuclear Imaging in Minority Populations (SCAN-MP) study investigates transthyretin cardiac amyloidosis (ATTR-CA) prevalence in Black and Caribbean Hispanic individuals with heart failure.
- Variations in recruitment percentages across study sites prompted an analysis of factors influencing eligible participant enrollment.
Purpose of the Study:
- To identify factors associated with higher enrollment percentages of eligible participants in the SCAN-MP study.
- To understand how recruitment strategies impact the enrollment of under-represented minorities (URMs) in clinical research.
Main Methods:
- Calculated enrollment percentage (enrolled/eligible participants) per site.
- Compared baseline demographics, clinical characteristics, health literacy, trust, discrimination perception, area deprivation index (ADI), and English proficiency across sites.
- Utilized Kruskal-Wallis, ANOVA, Chi-Square, and Fisher's exact tests, with false discovery rate (FDR) correction for post-hoc analysis.
Main Results:
- Harlem Hospital showed the highest enrollment rate (48%), followed by Yale (40%), Boston University (38%), and Columbia University (32%).
- Direct recruitment by the primary cardiovascular care team, higher education levels, and English proficiency were associated with increased enrollment.
- Enrollment differences were not linked to chronic disease burden, physician trust, perceived discrimination, or health literacy.
Conclusions:
- Recruitment success for under-represented minorities (URMs) in the SCAN-MP study was significantly influenced by recruitment strategies.
- Direct initial contact by the patient's primary cardiovascular care team emerged as a key factor for successful URM recruitment.
- Findings can inform improved strategies for recruiting URMs into clinical research, enhancing diversity and generalizability.
Background:
The Screening for Cardiac Amyloidosis with Nuclear Imaging in Minority Populations study seeks to determine the prevalence of transthyretin cardiac amyloidosis (ATTR-CA) among older Black or Caribbean Hispanic individuals with heart failure and an increased wall thickness. We noticed varied recruitment percentages across the recruiting sites and sought to determine the factors associated with greater percentage enrollment of eligible participants.
Methods:
The percentage of enrolled to eligible participants was calculated across study sites. Baseline demographic and clinical characteristics, health literacy, trust in providers, perceived discrimination, area deprivation index (ADI) and English proficiency were compared by site using Kruskal-Wallis's test or one-way ANOVA for continuous variables and the Chi-Square test or Fisher's exact test for categorical variables. Wilcoxon rank sum and Chi-Square tests, with multiple comparisons correction using the false discovery rate (FDR) method, were used as post-hoc analysis when results were statistically significant.
Results:
Among the four recruiting sites, Boston Medical Center, Columbia University Irving Medical Center, Harlem Hospital and Yale University, which employed different recruitment approaches, the percentage of participants enrolled among eligible participants differed, with the highest rate at Harlem Hospital (n=149 of 310, 48%), followed by Yale University (n=27 of 67, 40%), Boston University (n=247 of 655, 38%), and Columbia University (n=137of 442, 32%), p <0.01. Direct recruitment by the primary cardiovascular care team providing clinical care was associated with higher percent enrolled across sites as were higher education levels and English proficiency. Enrollment differences across sites were not associated with the number of chronic diseases, physician trust, perceived discrimination, or health literacy.
Conclusions:
Recruitment of eligible under-represented minorities (URMs) in SCAN-MP was associated with approaches employed in recruitment, including direct initial contact by the primary cardiovascular care team providing the potential participant's clinical care. Such data may help improve approaches to more successful recruitment of URMs in clinical research.
