How to close outcome gaps in cardiovascular care
Disparities in the management and treatment of cardiovascular disease are a global problem. Addressing them requires health systems to recognize that the barriers to care can vary substantially based on geography, socioeconomic conditions and population.
That was a key message from Anekwe Onwuanyi, MD, the chief of cardiology at Morehouse School of Medicine and medical director of the heart failure program at Grady Memorial Hospital, during a joint session with the American Heart Association (AHA) and European Society of Cardiology (ESC) during ESC Congress 2026. Onwuanyi examined cardiovascular outcomes in ethnically diverse and underserved populations. He then spoke to Cardiovascular Business about that discussion in a video interview with Cardiovascular Business.
Onwuanyi, a current AHA volunteer and former president of the Association of Black Cardiologists (ABC), said speakers from the United States, Europe and Egypt used the session to review disparities in cardiovascular outcomes, clinical-trial representation, medication affordability, social determinants of health and access to care. The discussion highlighted differences in how disparities are characterized across health systems. In the United States, cardiovascular research has traditionally placed greater emphasis on race and ethnicity, often alongside socioeconomic factors. In Europe, Onwuanyi said, analyses have more commonly focused on socio-economic differences.
Despite those differences, the underlying challenge is similar in all countries.
“Cardiovascular care and disparities in cardiovascular disease outcome is a global phenomenon,” Onwuanyi said.
Adapting cardiology care guidelines to local conditions
One of the challenges of reducing disparities is ensuring that evidence-based recommendations can actually be implemented in the environments where patients receive care. Guidelines may assume access to specialists, medications, diagnostic testing and other resources that are not universally available. Onwuanyi said health systems therefore need to adapt implementation strategies to local circumstances rather than relying on a one-size-fits-all model.
“We don't expect the same system in the U.S. to work in Europe, to work in North Africa and to other parts of the country or the world,” he said. “Adapting to your environment is critical.”
The Egyptian perspective presented at the session underscored that challenge. Cardiovascular disease in Middle Eastern and North African countries, where obesity, diabetes and hypertension are contributing to a substantial cardiovascular disease burden, are compounded by limited resources that can make prevention and treatment particularly challenging.
Establishing disease registries can help generate local evidence, Onwuanyi said, providing policymakers with data needed to develop and prioritize prevention and treatment strategies.
The session also examined sex-related disparities. Women remain underrepresented in cardiovascular clinical trials globally, potentially limiting the evidence base used to guide treatment. A greater representation of women in research, along with an increased focus on the differences in cardiovascular disease between men and women, could help improve clinical guidelines and outcomes.
Building care in cardiology deserts
In the United States, Onwuanyi said the ABC is focusing on another major barrier: geographic access to cardiology. The organization is conducting a pilot program addressing “cardiology deserts,” defined in the initiative as counties without significant cardiology representation. The effort encompasses both underserved rural and urban communities across four states.
Rather than simply identifying communities with limited specialist access, the program is working with local providers to develop infrastructure capable of delivering cardiovascular care closer to patients. The effort also incorporates education and seeks to establish models that could eventually be scaled to support broader clinical activities.
Onwuanyi said the program reflects the need to view resource limitations not only as challenges but also as opportunities to redesign how cardiovascular services are delivered.
Ensuring technology closes rather than widens healthcare gaps
Digital health and artificial intelligence could become important tools in addressing access disparities, but Onwuanyi cautioned that technology needs to be implemented intentionally. As healthcare systems increasingly use digital tools to support diagnosis, risk assessment and clinical decision-making, there is a risk that patients with limited access to technology, broadband, healthcare infrastructure or digital literacy could be left further behind.
The goal, he said, should be to ensure that digital transformation helps patients receive appropriate care when and where they need it.
"I think everyone in the cardiovascular ecosystem should be focused on how we can help mitigate these gaps and how we can help enable care to be delivered to the patients where they are. I think it is important that we are intentional in making sure that artificial intelligence works for patients and helps them get the care they need when they need it," he said.
Ultimately, closing cardiovascular outcome gaps will require more than expanding access to evidence-based medicine. Health systems must account for the social and economic environments in which care is delivered, improve representation in clinical research and develop care models tailored to local resources.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]