Shazli Khan, MD, Internal Medicine at the University of Pittsburgh Medical Center, talks about the human heart and how different races are affected
Let’s just start by asking a very basic question. Again, for our viewers have probably heard the term cardiomyopathy but they may not have a real good feel for what that is. Can you describe what’s happening if you’re talking about cardiomyopathy?
KHAN: Yes. I think a lot of people know that the heart is just a big muscle. And so cardiomyopathy is sort of just a fancy way of saying the heart muscle is diseased or it’s weak. Cardiomyopathy specifically is defined as a weak heart muscle that is ejecting less than the percentage it should be doing. So when we say how much blood the heart should be pumping out or squeezing with each contraction, normal is in the range of 55 to 60%. Anything above that is considered normal. When it gets to less than 50%, less than or equal to 50% rather, we call that cardiomyopathy.
And what’s happening to patients if it’s less than 50% is getting pumped out?
KHAN: Yeah. That’s a good question. It’s kind of a variable range. Some patients will have no symptoms from this, and that’s ideally what we hope. We hope to prevent it from progressing to something that is clinically significant. Over time if we don’t get patients on good medications and things like that, then they will progress to what we call clinical heart failure where they develop symptoms of shortness of breath and leg swelling. In the overall scheme of things, they just are more likely to get hospitalized and have the risk of even dying from heart failure.
Is medication the only option or are there some other things that can be done prevention wise for patients?
KHAN: There is a lot of things that can be done prevention wise, which is sort of what my study does look at. There’s a lot of other comorbidities that put you at risk for cardiomyopathy so sort of targeting those other comorbid conditions such as, like, diabetes and high blood pressure or things like that can help reduce that risk of progression of developing cardiomyopathy.
And we kind of backed into it a little bit, Dr. Khan. But if you could tell me about your research, what did you and your cohorts look at?
KHAN: We looked at all patients in the UPMC system. There were about 18,003 patients that came to us with the diagnosis of cardiomyopathy. The way we measured that was just based on this imaging study where we sort of take a look at how well the heart is squeezing. It’s called an echocardiogram. So based on that if their ejection fraction or if the percentage of blood they were squeezing out was less than or equal to 50%, then they have that diagnosis of cardiomyopathy. We took a look at all of those patients and in our system particularly, it was that number of patients. We then questioned, is there any sort of disparity between certain groups in terms of who progresses to clinical heart failure or who gets hospitalized more or who’s dying more from cardiomyopathy? In my project specifically we stratified patients by race, so we looked at Black patients versus white patients with cardiomyopathy. And we just looked at what comorbid conditions they came to us with beforehand, what medications they were prescribed, you know, what was their ejection fraction at baseline? What did it progress to? Who was getting hospitalized earlier? Who was dying earlier? What we actually found was that Black patients in our cohort had a much higher prevalence of a lot of chronic medical conditions, so more chronic kidney disease, higher blood pressure, higher rates of diabetes. In fact, they were actually dying more than the white patients with cardiomyopathy.
Any indication why this is? Why the disparity?
KHAN: We postulated a lot of things. This disparity like disparities in medicine are very widely known throughout the country. I definitely think this is not just applicable to this certain group of patients. In our group specifically, I think that the higher rates of all these comorbid conditions like the high blood pressure, diabetes, kidney disease that maybe was left undertreated just simply because the patients didn’t have access to the care or, you know, things like just not being caught early enough sort of played a role. We didn’t specifically look at other things like socioeconomic status and things like that, but that has been known to play a role in other health care disparities. We think that that might be playing a role in our group as well. It’s really hard to say, you know, to pinpoint and look at objectively, like, what is causing one group to do worse than another because our study was retrospective, meaning looking back in time on the data. I think in order to see what specific factors are influencing this, we’d have to look forward in time or do a prospective study to see if we did some sort of intervention, are patients doing better or worse based on that fact.
What are some of the takeaways from the research that you and your colleagues have done?
KHAN: I think honestly just being aware of the fact that there’s definitely this huge disparity in certain populations should make providers more like hyperaware that certain groups are more vulnerable to these diseases and making sure that they have adequate follow up, that they’re coming in to fill their medications, making appointments, giving them resources and sort of educating them on what the long-term effects of certain conditions are. Even just taking care of some of the other aspects of medicine that we don’t always think about but like social determinants of health, making sure patients have transportation to appointments, having the means to fulfill their prescriptions for medications, and perhaps just more regular follow up. I think that should be true for all patients, but just being a little bit aware that some groups are more vulnerable and checking in to make sure that they’re following up with everything that needs to be done.
I’d asked you earlier, I know that this was a population of patients here in Pittsburgh, but does this have nationwide implications?
KHAN: Yes. We’re not the first group to show that this is the reality of the situation, that there’s definitely disparities between racial groups in multiple fields of medicine, not just the cardiology world. I would say that this is definitely generalizable and it’s something that all providers should be thinking about across the nation.
Another question to ask you, the importance – why is it so important to be studying, cardiomyopathy on a whole but different population that are impacted by it?
KHAN: As I was saying, cardiomyopathy could actually not be clinically significant at all. Our hope is that if someone has that we don’t get them to the point where they progress to clinical heart failure. I think catching these things early, you know, the big implication of if you have cardiomyopathy that does progress, you could die from it, which I’m sure is a meaningful impact on everyone. It impacts everyone. In terms of being hospitalized, you know, we want to just kind of give them preventive methods from being in the hospital. I think focusing on the different vulnerable populations is especially important just because there are certain groups that are always going to be more impacted by this disease than others. So just being hyperaware of it and sort of preventing that from happening is important.
And you had mentioned a follow up study. Are there logical follow up studies from this?
KHAN: I think that what the future looks like is looking at a prospective approach to where we target one specific intervention, you know, either looking at hypertension or diabetes and seeing if we get those under better control, you know, and then look at following patients into the future, seeing if they do better.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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