SDOH Shape HCM Risk and Outcomes on Equity in Cardiac Care: Neha Hafeez, MD

Social determinants of health (SDOH) should be considered when assessing risk stratification, especially in cardiovascular disease, but more specifically in patients with hypertrophic cardiomyopathy (HCM).¹

SDOH is associated with an increased risk of heart failure and ventricular arrhythmias in patients with HCM, according to a recent study. Patient care should be considered holistically and factor in SDOH to better understand what parts of their care are actually accessible for the patient, lead author, Neha Hafeez, MD, a 3rd-year resident at the University of Pennsylvania Medicine, said in an interview with The American Journal of Managed Care^®.

Transcript

This transcript has been lightly edited; captions were auto-generated.

Why do you think SDOH have been underexplored in genetically driven conditions like HCM when compared with more traditional cardiovascular diseases?

I think part of this reflects how we conceptualize genetic disease. There's this implicit assumption that if a condition is genetically mediated, outcomes are primarily biological and relatively fixed, which can unintentionally deprioritize social context. Additionally, HCM care is often at tertiary or quaternary referral centers, which introduces selection bias automatically.

We know from our study that patients living in an area with lower income and a higher social deprivation index compared to the general population were underrepresented. Similarly, patients residing in an area with a worse social deprivation index were less likely to have undergone genetic testing, showing that the patients who face the greatest social or structural barriers are less likely to be represented in traditional research cohorts.

Also, from a more logistical perspective, social determinants data have not been historically captured well in our cardiovascular research data sets, especially in inherited disease research. As a result, even if there were investigators who are interested in these questions, we don't have the infrastructure to study them effectively. With the new EMR [electronic medical record], we're able to capture that better, but we're still there's still more work that needs to be done in this space.

How should clinicians factor in patient environments when thinking about risk stratification in HCM?

I think this means that clinicians should be thinking more holistically about the patient, beyond thinking about wall thickness or arrhythmia burden. We should also be considering whether patients have reliable access to specialty care, diagnostic testing, longitudinal follow-up, etc. For example, we know that cardiac myosin inhibitors are great new medications and are now the standard of care for treating patients with symptomatic left ventricular outflow tract (LVOT) obstruction.

However, the cost of them, the need for reliable insurance, and the availability to attend frequent clinic visits and echoes may be barriers for patients with adverse social determinants, and this is especially concerning given that we found that patients residing in more deprived areas have higher LVOT gradients at the time of diagnosis compared to those from higher incomes, suggesting that the patients who need the treatment more may be less likely to be able to access it. Newer cardiovascular risk models like the PREVENT scores incorporate these area-based social determinants and should also be applied to HCM management.

What actionable steps can clinicians take today to better address SDOH-related barriers and improve equitable access to care for patients living in low-income or highly deprived areas?

I think, first, screening for these barriers should be incorporated into our routine care. Identifying the challenges related to transportation, insurance coverage, and access to specialty care can help us tailor care plans based on what the patient can do. We should also be leveraging multidisciplinary resources, such as our social workers, care coordinators, and patient navigators, to create team-based, high-quality HCM care with a focus on increasing social determinants awareness.

And we should also be referring our patients earlier and having more proactive follow-up, which is particularly important for patients from more deprived areas. We know that these patients tend to present later, and we know that fragmentation of care and reduced health literacy disproportionately affect these patients, so continuity and early disease recognition are really important.

How should future research move beyond area-based measures of SDOH to better capture individual-level experiences, and what kinds of data would be most valuable to collect next?

Area-based measures are an important starting point, but as you said, they are proxies. Future studies are needed to incorporate more individual-level data that better capture the lived experience of financial strain, health literacy, trust in the health care system, etc. We know that even on one street in a neighborhood, everyone's experience is going to be different, and how they navigate through the health care system is different based on that.

To better understand the individual-level impacts that we see in prospective cohorts that intentionally enroll diverse populations is essential. We'll be able to integrate social data alongside genetic, imaging, and biomarker information to better understand how these factors integrate over time. My hope is that, in this study, we've documented these disparities, but next is to identify actionable targets for intervention and understand what we can do to better provide care for our patients in the future.

References:

1. Hafeez N, Claggett BL, Owens AT, et al. Social determinants of health and clinical outcomes in hypertrophic cardiomyopathy. JAMA Cardiol. Published online January 07, 2026. doi:10.1001/jamacardio.2025.4869