Health Equity Perspective on Data-Driven Treatment Decisions in Cardiovascular Care: Risk Assessments Versus...

Area of Science:

• Cardiovascular Medicine
• Health Disparities Research
• Biostatistics

Background:

• Medical decisions often rely on global risk scores, potentially overlooking individual variations.
• Heterogeneity in treatment effects suggests individualized treatment rules (ITRs) could enhance patient outcomes.
• This study examines racial and ethnic disparities in antihypertensive medication recommendations between ITRs and risk score approaches.

Purpose of the Study:

• To compare antihypertensive treatment rates derived from an estimated individualized treatment rule (ITR) versus a traditional risk score approach.
• To investigate potential racial and ethnic group differences in treatment recommendations under each method.
• To assess the impact of ITRs on maximizing survival times and mitigating health disparities.

Main Methods:

• Simulated observational data with treatment effect heterogeneity to compare ITR and risk score approaches.
• Estimated an ITR for antihypertensive prescribing using data from 3281 adults in the Multi-Ethnic Study of Atherosclerosis (MESA).
• Compared ITR recommendations with guideline-based risk scores, calculating hypothetical treatment rates and performing Chi-square tests on MESA data.

Main Results:

• Individualized treatment rules (ITRs) demonstrated two key benefits: maximizing expected survival and potentially reducing racial disparities in cases of treatment effect heterogeneity.
• The ITR recommended treatment for a greater proportion of participants across all racial and ethnic groups compared to the risk score method.
• A Chi-square test revealed statistically significant differences (P<0.001) in treatment rates between the ITR and risk score approaches across racial and ethnic groups.

Conclusions:

• Treatment recommendations differ significantly when employing an individualized treatment rule (ITR) compared to a standard risk-based approach.
• ITRs hold promise for optimizing treatment allocation and addressing health inequities in cardiovascular care.