Addressing Structural Racism in Heart Failure Care and Outcomes: A Mixed Methods Evaluation of The Social Structure of Care Delivery

The Why: Six million Americans have heart failure (HF), a debilitating, progressively chronic disease that is difficult to manage and profoundly impacts quality of life and survival. Racial and ethnic minorities (e.g., Black and Hispanic patients) tend to have more HF-related risk factors (e.g., diabetes, hypertension) and disproportionately higher HF prevalence. These populations are affected by significant disparities in HF care and outcomes as they are more likely to have their incident HF diagnosed in acute care settings, less likely to see a HF specialist or receive guideline-directed medical therapy (GDMT), more likely to have poor health-related quality of life, and more likely to have worse HF outcomes (e.g., mortality). Meanwhile, women have underutilized appropriate non-pharmacologic therapies across the spectrum of HF severity with Black women most impacted by biases in the allocation of evidence-based HF therapies. Structural racism and discrimination (SRD) are pervasive throughout the current system of HF care delivery in the U.S. and are key drivers of different HF care and outcomes that systematically disadvantage patients. This study focuses on disadvantages related to patient race, ethnicity, sex, socioeconomic status, and other identities by examining HF care delivery networks within this structure (i.e., the social relationships of providers supporting HF care delivery within and across organizations). While evidence-based HF care and outcomes require robust care delivery networks, networks serving racial and ethnic minority populations are systematically weaker, contributing to poorer access, care coordination, and outcomes. Objective: This proposal aims to address SRD in HF care by examining determinants of disparities and identifying stakeholder-informed areas of intervention within care delivery networks, which will inform a toolkit to enhance equitable HF care and outcomes. Our transdisciplinary team’s productive collaboration will leverage expertise across cardiovascular care and epidemiology, health equity and community engagement, mixed methods, and social network analysis to achieve the following aims: Aim 1: Evaluate the “social structure of care delivery” for populations disproportionately affected by SRD in HF care delivery and outcomes. Aim 2: Develop a comprehensive understanding of structural barriers and facilitators for equitable HF care and outcomes. Aim 3. Develop a best practices toolkit to address SRD in HF care and outcomes. This project aims to advance HF clinical practice guidelines by recommending strategies to address preventable disparities among populations disproportionately affected by SRD in HF care delivery. We aim to have a transformative impact on clinical practice by developing an actionable toolkit to address SRD determinants of care and outcomes for HF patients.