Cardiovascular Equity Research Program

Disparities exist in nearly every aspect of health, including quality of health care, access to care, utilization of health care and health outcomes. Despite notable improvements in the overall health of the United States during the past two decades, there continues to be striking disparities in the burden of illness and death experienced by African American, Hispanic/Latino/Latinx, American Indian, Alaska Native, Asian American, Native Hawaiian, and Pacific Islander populations.

Cardiovascular disease, the leading cause of death, further highlights the urgency of addressing these disparities. For example, according to a paper published in the July 2022 issue of Circulation, while age-adjusted mortality rates declined among both Black and White adults, Black women and men encountered higher cardiovascular mortality rates than White persons between 1999 and 2019. Furthermore, younger Black women are more than twice as likely to experience premature death from cardiovascular causes than White women, and Black women and men living in rural areas experience the highest cardiovascular mortality rates nationwide.

It is imperative to understand the impact of the various facets of disparities on advanced cardiovascular disease that include but are not limited to gender, race and socioeconomic factors.

From population studies to implementation science studies

Our Cardiovascular Equity Research Program, led by Khadijah Breathett, MD, MS, FACC, FAHA, FHFSA is focused on reducing racial, ethnic and gender disparities in treating advanced cardiovascular disease. Studies conducted may vary from randomized controlled studies and observational population studies to implementation science studies and community interventions that are designed to reduce racial, ethnic, and gender disparities through implementing best practices within the health care delivery system.

Dr. Breathett is a tenured associate professor of medicine at Indiana University School of Medicine and is a National Heart, Lung, and Blood Institute-funded principal investigator. Dr. Breathett is also an advanced heart failure transplant cardiologist at Indiana University Health, where she specializes in the prevention and treatment of advanced heart disease, including longitudinal heart transplantation and ventricular assist device care. She is nationally recognized for her portfolio of work focused on achieving racial, ethnic and gender equity in advanced heart failure care and led the development of Disparities Research Guidelines for the American Heart Association and American Stroke Association journals.

Dr. Breathett has published more than 100 manuscripts and has given more than 100 invited national and international lectures. She continues to lead impactful research on cardiovascular health equity that focuses on system and organizational change. She values mentoring the next generation of scientists that continue the momentum towards delivery of cardiovascular health equity.

“We know a disproportionate death rate and disease prevalence of heart failure remains amongst minoritized racial, ethnic groups and female patients,” Dr. Breathett said. “As scientists, we must understand the underlying mechanisms and develop strategies to address them and implement best practices. Throughout my career, I maintained a pulse on issues facing minoritized patients by listening to patients and their families, investing in the development of the next generation of scientists and physicians and supporting community events and initiatives, toward this continuous journey towards cardiovascular equity.”

Current Studies

Seeking Objectivity in Allocation of Advanced Heart Failure Therapies Trial (SOCIAL HF), NCT05390411

Goal: This multi-site randomized controlled pragmatic cluster trial/Type 2 hybrid implementation science study will assess real-world effectiveness and implementation of an evidence-based multi-component strategy to achieve equity in allocation rate of advanced heart failure therapies, heart transplants and ventricular assist devices. The study proposes the implementation of evidence-based strategies to reduce bias, replace subjective evaluations with objective criteria and improve group dynamics in a randomized controlled cluster trial, including the use of evidence-based bias reduction and anti-racism training to address these issues.

Study Launch: Fall 2021

Estimated Duration: 5 years

Estimated Enrollment: 1,463 patients

Cardiovascular Equity to Address Segregation Study (CEASe) 1.0

Goal: This study, funded through the Primary Care Reaffirmation for Indiana Medical Education (PRIME) program through the Health Resources and Services Administration at IU School of Medicine, will identify strategies to address disparities in cardiovascular care delivery, particularly by race. Structural racism can impact the care of Black patients with cardiovascular disease and contribute to poor outcomes. This study seeks to address structural racism in cardiovascular care by exploring three questions:

• When does segregation of cardiovascular care occur among Black and White patients?

• How and why do hospitals provide segregated cardiovascular care?

• How feasibly can segregation be modified?

Results of the study will come in the form of a toolkit with strategies to implement to achieve cardiovascular equity.

Study Launch: 9/2022

Estimated Duration: 2 years

TRAJECTORY Study: Changing Generational Trajectory of Cardiovascular Disease with the Adult Children and Grandchildren of the Women’s Health Initiative Study

Goal: This study extends the Women’s Health Initiative to a sample of adult children and grandchildren of participants currently enrolled in the Women’s Health Initiative and will provide strategies to address generational social determinants of health to inform the next trial and iteration of the Women’s Health Initiative. Current American families and their future generations are at greater risk of developing cardiovascular disease, and we do not fully understand how social determinants of health contribute to future cardiovascular disease across family generations. Moreover, strategies to correct social factors have been underpromoted. Understanding these important social factors is key to changing the trajectory of cardiovascular disease across family generations.

Study Launch: Fall 2023

Estimated Duration: 1.5 years

Addressing Individual Provider Bias and Group Decision-Making in Selection of Advanced Heart Failure Therapies in Racial/Ethnic Minorities, Project Number: 7K01HL142848-05

Goal: Understanding the role of bias in the selection of patients for advanced heart failure therapies is a critical step in creating health equity. This study will examine individual provider bias and the group decision-making process for selecting patients for advanced therapies for heart failure, heart transplants and left ventricular assist devices. We will identify the most important subjective eligibility criterion for advanced therapies and implement a standardized protocol that objectively measures this criterion.

Study Launch: 8/2018

Estimated Duration: 6 years