Heart Awareness Month and the Fight for Equity in Cardiac Care

By Stacy M. Brown

Senior Global Correspondent

With Black History the overarching theme during February, some may forget February also counts as American Heart Month and, many within the Black medical community are urging renewed attention to a crisis that continues to claim Black lives at higher rates, even as overall cardiovascular deaths decline nationwide.

Dr. Anthony Fletcher, the 20th president of the Association of Black Cardiologists (ABC) and an interventional cardiologist at CHI St. Vincent Cardiology and Medicine Clinic in Little Rock, Arkansas, said its time to confront persistent disparities that remain embedded in the health care system.“Every month should be Heart Month, and every month should be Black History Month,” Fletcher said in a telephone interview. “This is an opportunity to focus, to pause for a moment, and to think about the significance of both.” Fletcher was installed as president of the ABC during the organization’s spring 2024 membership meeting in Atlanta. Founded in 1974, ABC has a global membership exceeding 2,000 health professionals and advocates committed to improving cardiovascular outcomes in minority communities.While advances in cardiovascular care have driven down death rates over time, Fletcher said recent trends are concerning. He pointed to an upswing in cardiovascular deaths that many clinicians associate with rising diabetes and obesity rates. “Despite the improvements, there is still a gap in deaths among people of African American descent in this country,” he said. “The numbers are coming down, but Black people still die at higher percentages compared to our white counterparts.”Hypertension remains one of the most pressing threats, and Fletcher noted that high blood pressure often develops earlier in Black Americans, sometimes beginning in the late teens, and tends to be more severe. “It puts us at higher risk for congestive heart failure, kidney failure, and stroke,” he said. “Heart failure overall is rampant in the African American community.”A  graduate of Xavier University and the University of Cincinnati College of Medicine in Ohio, Fletcher also extended caution about transthyretin amyloid cardiomyopathy, known as ATTR-CM, a genetic condition that disproportionately affects Black Americans and is frequently overlooked.“It gets missed, even by doctors,” Fletcher said. “But ATTR is just one of many cardiovascular illnesses that disproportionately affect African Americans.”

Beyond individual risk factors, Fletcher said geography plays a decisive role in who receives timely care. He described what clinicians call cardiology deserts, areas with limited or no access to cardiologists.“There are at least three million African Americans who live in areas where they have access to no cardiologists whatsoever,” Fletcher stated. “Another 16 million live in places where access is limited.”To confront those barriers, the ABC launched its Cardiovascular Desert Initiative, a campaign started about five months ago and sponsored in part by Amgen. The pilot focuses on Georgia, Mississippi, Louisiana, and Arkansas, with host cities including Atlanta, Jackson, New Orleans, and Little Rock.The initiative focuses on communities, beginning with LDL-C cholesterol screenings and education around modifiable risk factors, and on providers, offering education on national guidelines, consultation access, and direct relationships with cardiologists.  “We want providers to be able to pick up the phone and call a cardiologist when a patient is not responding to treatment,” he said.Fletcher added that progress is visible, pointing to a growing number of Black cardiologists and improved enrollment of Black Americans in clinical trials. Still, he said more work remains. “We still have a gap,” Fletcher demanded. “We just need to work harder, enhance the workforce, and improve educational opportunities for early detection and early treatment.”The decorated physician noted the call to action must remain clear and sustained.“The first step is awareness,” Fletcher said. “We have risk factors that can be modified, hypertension, cholesterol, weight, activity levels, smoking. People need screening programs, early physicals, and to know their numbers, blood pressure, weight, sugar, cholesterol.”He said treatment must follow evidence-based goals.“Too many people are seen by providers but are not treated to goal,” Fletcher acknowledged. “Access matters. Education matters. Funding matters, so people can be screened and have access to the medications they need. Know your numbers,” he said. “Know your blood pressure, your weight, your sugar, your cholesterol.”