Another Example of How Health Care Disparities Kill

Atrial fibrillation, or AFib, is treated less aggressively if you’re not white and male

Health care disparities can lead to drastic differences in longevity between residents of different neighborhoods within American cities. Sadly, Chicago, where I live, is home to the largest such difference. A 2019 analysis of life expectancy gaps by New York University conducted in the 500 largest U.S. cities found that Chicago has a gap of 30 years: while residents of downtown Chicago live on average to be 90, residents of Englewood, Ill., just nine miles away, live on average to be only 60. Other cities are not far behind Chicago, with Washington, D.C., having a gap of 27.5 years; New York City with 27.4 years; and New Orleans and Buffalo, N.Y., both with gaps of 25.8 years.

Recently, my co-authors and I performed a medical literature research of known sex disparities in one particular type of cardiovascular disease, an arrhythmia problem called atrial fibrillation, or AFib, which can be a consequence of heart failure—and is also a leading cause of both heart failure and preventable stroke. It’s a complex disease, requiring comprehensive care. Reasons for these disparities are not completely known, but research has shown that white men present with symptoms to their doctors earlier and accept treatment more readily than women.

The showed that when it even when women do accept treatment, women were not as aggressively treated as men for preventing strokes and maintaining a normal heart rhythm. It turns out that there are also racial and ethnic differences when it comes to treating atrial fibrillation. In comparison studies of racial differences, the African American population, black men and women, were not as aggressively treated compared to white men and women. However, this disparity problem may not best be solved by cardiologists, but rather by patients themselves with the help of their primary care physicians.

There are several ways to treat atrial fibrillation and one way is to leave patients in AFib, give stroke preventing medications and control the heart rate to prevent heart failure. The other, more complicated treatment is to convert the rhythm by giving the patient an electrical shock to the chest; giving them medications to maintain a normal rhythm; or performing a procedure called catheter ablation to prevent further episodes. Studies done almost 20 years ago showed that there was no difference in strokes and deaths in treating patients with just controlling the heart rate versus preventing the atrial fibrillation from recurring.

Since then, the treatment has changed because of the increased availability of catheter ablation, which freezes or burns the tissues that cause the arrhythmia. This procedure can improve the patient’s quality of life—but data show that women and black patients are not getting the catheter ablation treatment as much as white men are.

As a cardiologist for 30 years who has taken care of thousands of patients with heart disease, I have seen the suffering of many patients from this terrible illness. Patients, no matter their race or gender, deserve the same care. Health care disparities lead to more patient suffering, unnecessary strokes, and deaths from AFib and other heart diseases. So, patients must be educated and informed by health care professionals about their options, and primary care physicians should understand the different options available to all patients with this disease. Patients can do their part to prevent atrial fibrillation by controlling their blood pressure, drinking alcohol only in moderation, preventing obesity, seeking help, and, if necessary, getting a second opinion about treatment.

Public health officials need to do more to get this information and patient care to communities that most need it. Health care disparities must be addressed by public officials and ensure that patients are informed about their options for their health. Any preventable stroke and death is one too many.