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Hospitalized patients of color experiencing hypertrophic cardiomyopathy—a condition that causes the heart muscle to thicken—are less likely than white patients to receive a key treatment that can prevent death, according to a study released this week by Mayo Clinic.
Patients of color are 13 percent less likely to receive an implantable cardioverter defibrillator (ICD) to treat this condition, according to the study. An ICD is a small device implanted inside the chest that detects and corrects irregular heartbeats.
Irregular heartbeat, or arrhythmia, is one of the classic symptoms of hypertrophic cardiomyopathy, said Dr. Sri Harsha Patlolla, a Mayo Clinic research fellow and one of the lead authors of the study. If not treated properly, arrhythmia can lead to cardiac arrest.
“When that happens, it can be potentially life threatening, which is why an ICD is one of the pillars of management for these patients,” Patlolla said.
The study found an even wider gender gap. Women across all races with hypertrophic cardiomyopathy are 28 percent less likely to receive this treatment than men. The findings are not encouraging, Patlolla said, but also not entirely conclusive.
“We cannot conclusively say there is definitely systemic bias with respect to women and patients of color, but there are signs that this is the case,” he said. “We need to dig into these differences more.”
Hypertrophic cardiomyopathy is a relatively rare medical condition, with an average of 200,000 new diagnoses each year nationwide, according to the Mayo Clinic. Most people who develop the condition do so between ages 40 and 60, and the causes are mainly genetic.
A thickened heart muscle makes it tougher for the heart to pump blood through the body. Common symptoms include chest pains and shortness of breath. Most of the time, people who develop the condition can get by with minimal treatment and lead normal lives, Patlolla said.
But hypertrophic cardiomyopathy can also lead to more serious consequences. Sometimes, for example, the symptoms are mild enough for people to ignore for extended periods of time. This can lead to a delay in diagnosis, prompting patients to get diagnosed when the disease is more advanced and they need more intensive treatment.
ICD implantation is a gold standard treatment for patients with a multitude of different heart diseases. Previous studies found similar race and gender disparities in ICD use for other diseases. Patlolla said similar findings in patients with ischemic cardiomyopathy, a condition that causes the heart’s left ventricle to expand and make more effort to pump blood, prompted him and his colleagues to see if similar discrepancies occurred for patients with hypertrophic cardiomyopathy.
Over the course of six months, Patlolla and five colleagues analyzed records of roughly 24,000 people hospitalized nationwide with the condition between 2003 and 2014.
The study looked specifically for whether ICD discrepancies on hypertrophic cardiomyopathy patients existed. As to what’s causing them, Patlolla had some clues, but added that more research needs to be done.
Patients of color with hypertrophic cardiomyopathy were less likely to be treated at large teaching hospitals, which Patlolla described as “centers of excellence.” Women with hypertrophic cardiomyopathy were more likely to be diagnosed with the disease at an older age than men, which increased their likelihood of severe symptoms. In these cases providers can delay or forgo ICD implantation and instead focus on immediately relieving their symptoms with more intensive procedures like septal myectomy, a form of surgery that removes part of the heart muscle.
This initial report will likely lead to more research at Mayo Clinic taking a deeper look at whether systemic bias is causing the discrepancies, Patlolla said. Until then, Patlolla said the biggest takeaway from the study’s results shows a need for multidisciplinary care for patients with hypertrophic cardiomyopathy.
“If we are able to get all patients identified with hypertrophic cardiomyopathy to a large center of excellence, I’m pretty sure we can mitigate these differences,” he said. “Because I think that is where it all stems from.”