(The Dallas Examiner) –“It’s important to note that racism, either structural or interpersonal, negatively affects the health of people of color with many diseases, including valve disease. The disproportionate impact of risk factors for heart valve disease on people of color is just one example of these health disparities,” Katin Werner-Perez, health program manager with Alliance for Aging Research, explained as she opened at a recent webinar.
Black Americans experience risk factors for valve disease, such as high blood pressure and heart failure, at higher rates and earlier ages than their White counterparts. This makes the average age of valve disease onset among Black Americans younger. Because the disease is often thought of as being age-related, valve disease often goes undetected and untreated in Blacks when compared to Whites.
“1.6 million people are living with tricuspid heart valve disease in the United States. Of those that are undergoing tricuspid surgery, 60% of patients are White, while Black and Hispanic patients represent only 10% and 6%, respectively.”
The webinar – Heart Valve Disease: Its Effects in the Black Community – recently hosted by the National Caucus and Center of Black Aging, discussed the intricacies of heart disease and its specific risks for Black and African American people. Furthermore, the event explained the distinctions between heart valve disease from other heart conditions and preventative measures through healthy living.
The heart and valve disease
“To understand more about valve disease, we need to understand how the heart works,” Werner-Perez stated.
The heart is an organ responsible for continuously circulating blood throughout the body. It contains four chambers that squeeze and relax in a coordinated manner to pump blood to the lungs and through the circulatory system to deliver oxygen and nutrients. Between each chamber is a valve. A valve is a thin leaflet of tissue that keeps the blood moving in one direction and with the right amount of force. The valves keep blood from leaking backward. There are four valves: tricuspid, pulmonary, mitral and aortic.
“Valve disease is a type of heart disease that involves damage to one or more of those four valves that causes them not to open or to close properly and disrupts blood flow,” Werner-Perez stated.
If a valve doesn’t close entirely and allows blood to leak backward, it’s called regurgitation or insufficiency, often called a leaky valve. If a valve doesn’t open fully to allow enough blood to flow through, it’s called stenosis, sometimes called a sticky, narrowed, or stiff valve.
Valve disease reduces blood flow to the body and forces the heart to work harder. This causes a number of symptoms, many of which only occur during exercise or activity. But, as valve disease worsens, symptoms may occur while resting. Symptoms include feeling lightheaded, faint or dizzy; irregular heartbeat, heart flutter or chest pain; shortness of breath after light activity or while lying down. People also experience tiredness even if they’ve had plenty of rest; edema or swelling of the ankles and feet; and not feeling like themselves – like missing out on daily activities.
“Without treatment, valve disease can lead to serious complications including arrhythmias, congestive heart failure, stroke, other heart disease and even death,” Werner-Perez stated.
Complications can significantly impact quality of life, make everyday activities difficult and lead to disability and loss of independence.
Valve disease is usually caused by wear and tear, disease or damage. Risk factors for valve disease include older age, congenital abnormalities, family history, infection, radiation to the chest and certain chemotherapies, cardiovascular diseases and conditions, and other health conditions.
Socioeconomic factors that influence the American health care system
Experiences of racism have been associated with reduced trust in the health care system and lower patient satisfaction.
“Inner circles still know people, if not impacted directly, have some close association with the Tuskegee experiment, and there’s no way that you can go through something like that and make sure that you haven’t been adversely impacted in some way. So, that’s something that we just have to open our eyes about and understand why the trust deficit exists,” Aaron Horne Jr, MD, whose clinical focus is on the fastest growing population in the U.S., those who are 85 years and older, expressed.
Among Medicare beneficiaries aged 65 and older, patients of color are more likely to report delays or challenges in health care access than White patients.
Up to 8% of Americans aged 65 and older have skipped a physician visit or medical test/treatment due to concerns about cost. Patients treated in rural clinics have the worst underutilization.
Horne stated that the number of Americans aged 65 and older is projected to increase by 75% between 2019 and 2060. The projected population increases between 2019 and 2040 are expected to be most significant for racial and ethnic minorities. Also, among Americans aged 65 and older, women are expected to continue outnumbering men.
“Prevalence of heart disease, including valve heart disease, is expected to rise as the population ages,” Horne stated.
Approximately 1 in 10 Americans aged 65 and older have moderate or severe valve heart disease.
Pervasive and severe disparities exist in access to high-cost cardiac procedures for minority groups and groups of low socioeconomic status. Also, women referred for mitral intervention have more complex degenerative disease, more annular calcification, and more mitral stenosis than men.
“Hispanics and non-Hispanic Blacks and other minorities get treated less aggressively as it pertains to these, you know, advanced technological treatments, and so it’s important that we’re cognizant of this part and making sure that we hold physicians accountable to making sure we’re aware of our implicit biases,” Horne said.
To address the disparities in treatment, Horne shared the following strategies:
- Culturally competent communication, including shared decision-making between providers and patients
- Policies enhancing access to care
- Team-based health care, including between and within the site and multidisciplinary heat team processes
- Acknowledgment that disparities exist and need to be addressed
- Improving patient education, health care access, and accurate diagnosis
- Changing research paradigm, including increased enrollment of minority populations in clinical trials
- Enhancing physician awareness and understanding of disparities in Aortic Stenosis
- Diversifying physician and hospital workforce
- Partnerships between all relevant stakeholders
“This is not something that is so complicated that it cannot be fixed. We know what needs to be fixed,” Horne closed.