How cardiologists can address health disparities in their communities

As the current ACC vice-president, he said he works to stay in touch with the strategic mission of the ACC, which includes increasing diversity, health equity and inclusion. This includes having a chief diversity officer, for example, and a young scholars program designed to raise interest in cardiology with underrepresented groups of students.

ACC is also a big advocate for the use of wearable technologies to help increase patient assessment or monitoring remotely in the community. Wilson said studies have shown there is no difference in the level of use of smartphones between socio-economic groups. This means the use of wearables that can interface with smartphones to communicate with a care team is feasible, even in lower-income areas that may have poor access to internet and computers. 

"These can be used in the community so a patient does not necessarily need to be tried to a hospital or an office and you can get a wealth of information to try and help them with their their care and keep them out of the hospital," Wilson said. "The wearable monitor can feed data into their smartphone that can then be sent on to a healthcare provider to help monitor and direct their medical therapy for hypertension or heart rhythm issues."

The remote hypertension monitoring program is sponsored by a multi-million dollar grant from the William, Jeff, and Jennifer Gross Family Foundation.

How Sanger Heart and Vascular Institute is addressing hypertension health disparities 

Wilson is also the executive vice chair for Atrium Health Sanger Heart and Vascular Institute as well as an interventional cardiologist. During his time there, he has been involved in three programs that took action to deliver health equity to help deliver better healthcare to underserved populations.

At Sanger, he said they targeted hypertension issues with lower income patients in the community through a hypertension "boot camp" program. This includes patients using wearable blood pressure monitors that sync with their smartphones to track blood pressure. This data interfaces with a nurse navigator at the hospital who monitors the patients over a six-week period to try and get them into normal ranges and help show them how they can lower their blood pressure. 

"We have seen in hundreds of patients that have been identified in clinics that we can reduce their risks by bringing their blood pressure down to a more normal range," Wilson explained. "They are fitted with a special blood pressure cuff they can take home that is keyed into their smartphone and their measurements can be take once or twice a day and sent to a nurse navigator who can then direct their medications."

Wilson also noted that controlling hypertension is seen as a major preventive effort in reducing cardiovascular issues down the road, but large numbers of patients are not being monitored or treated, which causes downstream hospitalizations years later after the slow progression of damage is done.

"Hypertension seems like a simple thing to treat, but it is alarming how many people are undertreated, or have no treatment at all," he said. "It can make such an incredible impact if you can just keep people at normal blood pressure over the years they can avoid heart attack, strokes, kidney damage and so many other things. And a lot of it is just having patients aware of their blood pressure."

Critical limb ischemia disproportionally impacts Black patients

Another program at Sanger is tackling critical limb ischemia (CLI). Wilson said minorities, especially Blacks, have much higher rates of peripheral vascular disease, which leads to the loss of limbs if left untreated. 

"If we can identify and treat these patients sooner, we can prevent them from loosing a leg," Wilson said. "This takes them out of the workforce, it adds a lot more expense, and greatly lowers their quality of life." 

The CLI program is funded through a grant from Johnson and Johnson. 

Use of echo to decrease the numbers of undiagnosed aortic valve stenosis patients

A third program at Sanger identifies patients with severe aortic stenosis. With the introduction and rapid growth of transcatheter aortic valve replacement (TAVR) over the past decade, cardiology was surprised to find many more patients coming forward seeking treatment than what was previously thought to be the treatable population. In recent years it has been recognized by cardiology societies like ACC and the American Heart Association (AHA) that aortic stenosis patients are significantly underdiagnosed and undertreated. This is especially true to lower-income and minority populations. 

The current standard of care when a patient has an echocardiogram is to send the final report with information on the valve to the referring physician and let them decide what to do next. 

"We are being more pro-active and after we identify those patients, suggesting to whoever made those referrals that this patient could be reviewed by our structural heart clinic for a TAVR valve," Hadley said. "So we now suggest a consult to both the referring physician and to the patient. We know that about 50% of these patients once diagnosed will pass away within two to five years if they are not treated."

Identifying atrial fibrillation with remote monitoring

Another community program at Sanger is the use of remote monitoring devices that interface with smart phones to detect atrial fibrillation (AFib) earlier to get patients anticoagulation medications and consults on other electrophysiology treatment options. 

This and the other programs mentioned above are conducted at special community outreach events, usually on weekends and at locations with access to the community such as churches or community centers. Handley said they also have mobile units that go out and set up in parking lots offering free cardiovascular screenings. He said the mobile units started with COVID-19 vaccination efforts, but value was seen in using this platform to reach patients for other public health needs. 

"The whole point is to be able to reach them and treatment them as out patients for their better quality of life and before they start to have serious problems that require hospitalization," Hadley explained. "If we can treat patients before they need to be hospitalized, you are actually going to save healthcare dollars."

Bringing in new patients for hospital

Wilson said screening and monitoring programs can increase the number of referred patients for treatment at a hospital system, that that is never the primary reason he or Sanger pursue such opportunities. Their biggest motivation is always to give back to the community and help prevent serious hospitalization from happening, which can raise healthcare costs for the health system. 

As a non-profit hospital, he said Sanger hopes to just break even or have these programs supported by grants. 

Wilson added that these programs are all models that other hospitals and health systems could follow to improve the health of their own communities.