Cath Lab Team 'Not Off the Hook' for Racial Disparities in Medicine

Interventional cardiologists have as much a part to play in eliminating decades-old racial disparities in cardiovascular care as their colleagues and stakeholders, a lecturer suggested at this year's virtual scientific sessions of the Society for Cardiovascular Angiography and Interventions (SCAI).

"Racial disparities exist in interventional cardiology, and admittedly, many of those things are out of our control. If you're like me, you often meet your patient on the cath lab table. That patient on the cath lab table has overcome social determinants of health, they've overcome a lack of access -- they've overcome the lack of access to a doctor who refers him for the right procedure," said Quinn Capers IV, MD, of UT Southwestern Medical Center in Dallas.

"However, when things are in our control, disparities still exist. So we're not off the hook," said Capers, who is also chair of the American College of Cardiology (ACC) Diversity and Inclusion Committee.

In 2014, Capers' group identified at least 300 papers documenting Black-white disparities in cardiovascular care over a 20-year period.

"The sobering thing we found out in that review paper was that things were just as bad at the end of that 20-year period, [after] documenting the problem 300 times, as at the beginning of that 20-year period. So we keep documenting the problem, and documenting the problem, and documenting the problem. But nothing is getting better," he lamented.

Persistent racial disparities can be observed in cardiac catheterization for acute coronary syndrome and revascularization in critical limb ischemia.

"Maybe we're offering Black patients all of these techniques, but they're turning it down. If there are trust issues, it is with good reason," he said. "So we don't call that hesitancy when Black patients are a little skeptical. We call that intelligence based on how they've been mistreated, [and the] inadequate resources at hospitals that treat a large number of Black patients."

Capers urged transitioning from documenting racial gaps to taking concrete action to eliminate them. His suggestions for interventional cardiologists included:

• Assigning an equity auditor on each team to parse through quality improvement program data and investigate reasons for observed racial disparities
• Community engagement and outreach for newer therapies (e.g., enhancing diversity in clinical trials, outreach at the high school level)
• Bias mitigation training as an entire cath lab team
• Enhancing diversity in interventional cardiology fellowship training programs

The ACC Board of Trustees already took bias mitigation training. SCAI agreed to provide such training to its board of trustees as well, Capers noted.

"Just like the team looks to you, when things are going wrong in the cath lab, they look to your leadership when they see you stand up against racism. They will follow your lead," Capers said.

For his own part, he cited as inspiration the late Alphonzo Jordan, MD, a founder of the Association of Black Cardiologists and someone who is thought to be the first Black interventional cardiologist.

"So when I think I'm tired of being the only one in the room, I think of Dr. Alphonzo Jordan," Capers said.

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