Authors find non-adherence to be a ‘driving force’ behind racial/ethnic disparities in cardiovascular disease, suggest strategies to address problem
The fact that blacks are less likely than their white counterparts to take their prescribed medications is a major reason why they are 2-3 times as likely as whites to die from preventable heart disease, according to a new Journal of Clinical Hypertension report. The authors investigate the relationship between health disparities and patients taking their medicines, and offer strategies to address the problem.
“One prominent goal in keeping people healthy includes improving outcomes for priority populations, especially the African-American/black population. There remain significant cardiovascular health disparities and this paper provides evidence of potential effective interventions,” said Dr. Keith C. Ferdinand, lead author of the report and professor of medicine at the Tulane University School of Medicine.
The article, Disparities in hypertension and cardiovascular disease in blacks: The critical role of medication adherence, stems from the U.S. Food and Drug Administration’s Enhanced Medication Adherence Strategies Initiative (EASi), which supports the Million Hearts® initiative to prevent one million heart attacks and strokes by 2022. The FDA signed a first-of-its-kind memorandum of understanding with the National Forum for Heart Disease & Stroke Prevention to engage private sector collaborators in EASi.
“Our publication and the overall work of EASi is to support the goals of Million Hearts® 2022,” Dr. Ferdinand said. “African Americans have a much higher risk of hypertension and our final goal is to educate patients and providers to improve adherence and contribute to the final achievement of health equality.”
Joining Dr. Ferdinand as report authors are FDA medical officer Dr. Fortunato Fred Senatore; Dr. Helene D. Clayton-Jeter, director of the Cardiovascular and Endocrine Liaison Program at the FDA; Dr. Kapil Yadov, cardiovascular disease fellow at the Tulane Heart & Vascular Institute; Dr. Samar A. Nasser, director of clinical health sciences at the Department of Clinical Research & Leadership at the George Washington University school of medicine; Dr. John Lewin, principal and founder of Lewin and Associates LLC and chairman of the National Coalition on Health Care; and Dr. Dennis R. Cryer, chief medical officer of CryerHealth.
“This report calls out the impact of low medication adherence on health and health equity of African Americans and charges us all to help reduce barriers to taking medications as prescribed,” said Janet Wright, M.D., executive director of Million Hearts®. “Greater medication adherence is possible and when achieved, fewer people will have heart attacks, strokes, heart failure, and kidney disease – and many more days of good health.”
Through their comprehensive review, the report’s authors found that non-biological determinants, such as communication between patients and doctors, and cultural and socioeconomic differences, are key factors affecting whether patients take their medicine, and, consequently, their health. For example, despite dramatic improvements in U.S. cardiovascular disease mortality, blacks remain nearly twice as likely as whites to die from preventable heart disease and stroke.
The authors recommend eight practical approaches to improve medication adherence with the greatest potential to reduce this tragic disparity: 1) patient engagement strategies, 2) consumer-directed health care, 3) patient portals, 4) smart-apps and text-messages, 5) digital pillboxes, 6) pharmacist-led engagement, 7) cardiac rehabilitation, and 8) cognitive behavior therapy.
“This article highlights the human and economic toll of having lower consistent use of medications in the black population than the population at large, and gives us an added sense of urgency to resolve it,” said John M. Clymer, executive director of the National Forum for Heart Disease & Stroke Prevention. “The magnitude of unnecessary deaths, disability and costs say that this is a public health crisis. We know ways to solve it, and it should be a national priority to do so.”
To read the full article in Journal of Clinical Hypertension, view Disparities in hypertension and cardiovascular disease in blacks: The critical role of medication adherence.
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