Courtney Bess, MD, MS; Daphne Ferdinand, RN, PHD; Paul Underwood, MD; Donnell Ivy, MD, MPH; Michelle A. Albert, MD, MPH; Anekwe Onwuanyi, MD; Cassandra McCullough, MBA; LaPrincess C. Brewer, MD, MPH; on behalf of the Association of Black CardiologistsCommunity Programs Committee

The objective of this paper is 2-fold: 1) to illustrate how a medical professional society, the Association of Black Cardiologists, Inc (ABC), designed and implemented a practical model (the ABC CHAT program) for developing sustainable community partnerships focused on promoting CVH equity in underserved communities; and 2) to issue a call to action for medical professional and health care organizations to embrace and integrate such partnerships into their core mission.

The ABC CHAT pilot program is a practical model of culturally congruent community engagement that could be emulated and adopted globally by medical professional societies and health care organizations to: 1) increase community awareness about CVD and associated risk factors; 2) equip community health leaders with knowledge and skills to educate community members about CVH lifestyle changes within their sociocultural contexts; and 3) serve as liaisons between the community, medical professional societies and health care systems.

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Norrisa A. Haynes, MD, MPH, MSHP; Michelle Johnson, MD, MPH; Sabra C. Lewsey , MD, MPH; Kevin M. Alexander , MD; D. Edmund Anstey, MD, MPH; Tierra Dillenburg, BS; Joyce N. Njoroge , MD; Debra Gordon, MS; Elizabeth O. Ofili, MD, MPH; Clyde W. Yancy , MD, MSc; Michelle A. Albert , MD, MPH

ABSTRACT: The COVID-19 pandemic exposed the consequences of systemic racism in the United States with Black, Hispanic, and other racial and ethnic diverse populations dying at disproportionately higher rates than White Americans. Addressing the social and health disparities amplified by COVID-19 requires in part restructuring of the healthcare system, particularly the diversity of the healthcare workforce to better reflect that of the US population. In January 2021, the Association of Black Cardiologists hosted a virtual roundtable designed to discuss key issues pertaining to medical workforce diversity and to identify strategies aimed at improving racial and ethnic diversity in medical school, graduate medical education, faculty, and leadership positions. The Nurturing Diverse Generations of the Medical Workforce for Success with Authenticity roundtable brought together diverse stakeholders and champions of diversity and inclusion to discuss innovative ideas, solutions, and opportunities to address workforce diversification.

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Rachel M. Bond , MD; Kecia Gaither, MD; Samar A. Nasser, PHD, MPH; Michelle A. Albert, MD, MPH; Keith C. Ferdinand, MD; Joyce N. Njoroge, MD; Biljana Parapid, MD, PHD; Sharonne N. Hayes , MD; Cheryl Pegus, MD, MPH; Bola Sogade, MD; Anna Grodzinsky, MD; Karol E. Watson, MD, PHD; Cassandra A. McCullough, MBA; Elizabeth Ofili, MD, MPH; on behalf of the Association of Black Cardiologists

ABSTRACT: Following decades of decline, maternal mortality began to rise in the United States around 1990—a significant departure from the world’s other affluent countries. By 2018, the same could be seen with the maternal mortality rate in the United States at 17.4 maternal deaths per 100000 live births. When factoring in race/ethnicity, this number was more than double among non-Hispanic Black women who experienced 37.1 maternal deaths per 100000 live births. More than half of these deaths and near deaths were from preventable causes, with cardiovascular disease being the leading one.

To amplify the magnitude of this epidemic in the United States that disproportionately plagues Black women, on June 13, 2020, the Association of Black Cardiologists hosted the Black Maternal Heart Health Roundtable—a collaborative task force to tackle the maternal health crisis in the Black community.

The goal of this roundtable was to identify current barriers at the community, patient, and clinician level and expand on the efforts required to coordinate an effective approach to reducing these statistics in the highest risk populations. Collectively, preventable maternal mortality can result from or reflect violations of a variety of human rights—the right to life, the right to freedom from discrimination, and the right to the highest attainable standard of health.

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As the leading national organization committed to advancing equity and preventing and addressing health disparities within cardiovascular health, on June 20, 2023, the Association of Black Cardiologists (ABC) held its fourth invitation-only roundtable symposium in advancement of the ABC’s Access to Care Initiative.¹² The first three roundtables were held in 2016, 2017, and 2019, all focused on improving health care access and outcomes for Black and other high-risk patients and communities. The June 2023 convening, “Improving Health Care Access and Outcomes for Minority and High-Risk Populations” was attended by an interdisciplinary group of nearly 60 stakeholders, including government officials, clinicians, researchers, members of national medical and public health associations, industry representatives, and patient advocates.

Racial and ethnic disparities in cardiovascular disease are extensively documented and show that members of racial/ethnic populations carry a disproportionate burden of myocardial infarction, heart failure, and stroke and experience other cardiovascular events at higher rates than whites—and fare worse after these events, including higher mortality rates and higher prevalence of unrecognized and untreated risk factors.¹³ As such, the goal of the meeting was to identify challenges and barriers that prevent members of racial/ethnic populations and high-risk patients from accessing high-quality and affordable care and enumerate the action steps that the federal government, health plans/payors, industry, clinicians, medical professional organizations, and patient advocacy groups can take to address health disparities and advance equity for heart patients nationwide. Roundtable participants were provided with and guided by an adapted definition of “access to care” from the National Academies of Sciences, Engineering, and Medicine (NASEM):

“An individual has timely and affordable access to the care, services, prescription
therapies, and other supports (e.g., transportation, food) they need to achieve
the best possible health outcome.”¹

¹ABC Access to Care Initiative. Association of Black Cardiologists. https://abcardio.org/advocacy/abcaccessinitiative/#:~:text=We%20believe%20that%20good%20health,committed%20to%20advocacy%20and%20diversity
¹²ABC Access to Care Initiative. Association of Black Cardiologists. https://abcardio.org/advocacy/abc-accessinitiative/
¹³Bonow RO, Grant AO, Jacobs AK. The cardiovascular state of the union: confronting healthcare disparities.
Circulation. 2005;111(10):1205-1207. doi:10.1161/01.CIR.0000160705.97642.92

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The event, held in Washington, D.C., brought together a multi-disciplinary and diverse group of stakeholders committed to improving diagnosis, treatment, and outcomes for minority patients with valvular heart disease (VHD). The impetus for the convening was to follow-up from a February 2017 ABC-hosted roundtable during which attendees identified top barriers contributing to – and solutions to address – health disparities and poor outcomes for minority patients with VHD. Following that discussion, ABC issued a paper, “Addressing Disparities in Contemporary Care of the Minority Patient with Valvular Heart Disease Summary Recommendations.”

In June 2017, the ABC convened its first roundtable discussion on disparities in VHD. At the time, there was a still-evolving technological innovation, TAVR, which was creating an important practice change in VHD and the challenge – if the process was not managed correctly – was that it had the potential of widening the gap in care for minority patients. At that time, roundtable participants identified several barriers to care, including a lack of awareness about both the disease state and available treatment options like TAVR; significant research gaps; and limited minority participation in clinical trials.

Following the 2017 discussion, ABC proposed a set of recommendations aimed at increasing disease state and treatment awareness of VHD. Suggested efforts included, but were not limited to:

1. Conducting pre-TAVR or surgery surveys to address patient concerns and promote shared decision-making
2. Utilizing health data sources (e.g. public health surveillance data, electronic health records, and insurance claim data) to better understand reasons for VHD treatment hesitancy and refusal
3. Developing a diverse task force to address disparities in VHD care
4. Building an effective national campaign to increase education and awareness around VHD

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