Dr Khadijah Breathett Explains How COVID-19 Is Used to Address Disparities in Cardiovascular Outcomes and Care

Khadijah Breathett, MD, MS, FACC, FAHA, FHFSA, is an assistant professor in the University of Arizona College of Medicine--Tucson, Division of Cardiology. She is presenting a talk at the American Heart Association (AHA) Scientific Sessions, "COVID-19 as a Catalyst to Address Disparities in Cardiovascular Outcomes and Inequities in Cardiovascular Care Delivery.”


Can you discuss the major themes you will be addressing in your talk, “COVID-19 as a Catalyst to Address Disparities in Cardiovascular Outcomes and Inequities in Cardiovascular Care Delivery”?

In this session, we're going to be addressing how this pandemic has really devastated these populations: populations of color and women, beyond even heart failure, but with cardiovascular disease. I think some of the key things that we've learned are that there are systematic inequities that are progressively worsening to, potentially, the point of no return. It's imperative that we start to take the steps to address them and correct them if we don't want to continue just talking about the disparities year after year.

In this talk, I address some of the current issues that are present with cardiovascular disease. It's the leading cause of death of all people groups, but it's disproportionately killing people of color, particularly Black individuals. There's still a lot of issues with receipts and allocation of vaccines with the ability to work from home, with the opportunities to excel at a person's workplace, and how all these issues impact one's health and one's cardiovascular health. The imperative is on the community, on our policymakers, and our stakeholders to start to address the root cause of these problems—the structural racism, the social determinants of health and bias—if we truly want to change the way that things are going, if we want to make things better, if we want to end this pandemic. That presentation focuses on this.

Before COVID-19, both the AHA and ACC meetings featured discussions on the fairness of CMS quality measures. Discussions have centered on whether measures in heart failure account for disparities; as a result, the measures may penalize safety net hospitals that care for a higher share of patients who are socially and economically disadvantaged. What has been your experience?

There's obvious inequities, obvious issues with the policies and structures that are currently in place that need to be looked at a little bit differently. I am in favor of using tools like implementation science, where we look at these policies and see whether or not it changed and did what it was intended to do, and if it did not, to obtain the appropriate feedback to see how do we change it, how do we make the next iterations so that it can do what it's intended to do. I think there's an abundance of data that show things like with the penalties for heart failure, rehospitalization, that a number of changes are needed if we're going to try to get the policy to do what was intended, which is to improve care, to improve access to care. Unfortunately, we know with this policy, it's actually resulted in reduction in hospitalizations but increase in mortality.

We have to—with any policy that's put in place—make sure that it's, 1, doing what it's intended to do, and, 2, we have to really care about equity and decide that equity is a priority, meaning that it doesn't matter what your race or sex is, you're going to get the care that you deserve. That's going to require looking at things from a racial lens because we live in a racist society. I believe that there is intent in the desire to make these changes, but a lot of additional work is needed to actually put them into place. With the education of the public and increased awareness, I hope that individuals will be willing to decide that they're going to do the work to make these changes, to speak up about things that maybe don't impact them but know that impacts their fellow human being, and willing to be uncomfortable so that we can make sure that everyone gets an equitable opportunity to the care that they need and deserve.