• Work Still Needed to Achieve Diverse Workforce, Representative Clinical Trial Patient Pools in Interventional Cardiology – CRT Disparities Session

    Despite recent efforts, the field of interventional cardiology still has a ways to go in achieving a diverse workforce and representative patient pools for clinical trials, presenters said on Saturday during CRT 2021 Virtual.

    During their respective presentations, Ki Park, MD, MS, of the University of Florida, and Joaquin E. Cigarroa, MD, of the OHSU Knight Cardiovascular Institute, Portland, Oregon, both cited previous iterations of the Association of American Medical Colleges’ (AAMC) Physician Specialty Data Report, which tracks gender diversity in medical specialties.

    “Although the U.S. population has almost equal representation of women and men,” Cigarroa said, “that is not true in cardiology, where a very small fraction of our workforce (is) comprised of women.”

    According to the most recent data from the AAMC, cardiology ranks 38th and interventional cardiology ranks 45th out of 47 disciplines regarding the percentage of women in the specialty. The percentage of women in cardiology is 15%, with the share being even lower in interventional cardiology, at 8%.

    “The trends in these areas really have not changed much in the last few decades,” Park said.

    Park also cited a study by Celina M. Yong, MD, and colleagues, published in 2019 in the Journal of the American College of Cardiology (JACC), which surveyed 574 cardiovascular fellows-in-training. Of those, only 17% of women surveyed reported anticipating specializing in interventional cardiology, compared to 39% of men.

    Showing data compiled by the AAMC in 2018, which detailed the racial and ethnic makeup of internal medicine faculty, Cigarroa said, “The workforce is dominated by whites in this country, with only a small percentage of individuals being Black or Hispanic.”

    “This impacts how we educate our medical students, residents, fellows, and also areas of interest for research and clinical trials,” he said.

    These disparities also extend to the makeup of patients enrolled in clinical trials.

    Even though they have some of the highest cardiovascular mortality rates, Blacks and Hispanics also remain a small population group in clinical trials.

    Cigarroa highlighted a 2020 study published in JACC that measured the impact of race on percutaneous coronary intervention outcomes. Led by Mordechai Golomb, MD, of the Cardiovascular Research Foundation’s Clinical Trials Center, the study found that Black and Hispanic patients had the two highest mortality rates over a 5-year period (23.9% and 21.5%) despite only making up 4.1% and 2.1% of the total patient population (N=22,638), respectively.

    The use of transcatheter aortic valve replacement among racial minorities, Cigarroa noted, remains “very low.”

    “We know that historically, again, (racial and ethnic minorities) remain underrepresented, and even to this day that persists,” Rachel M. Bond, MD, of Dignity Health, Arizona, said. “Especially when we focus on cardiovascular research.”

    In her presentation, Bond noted a 2011 U.S. Food and Drug Administration white paper that found that even though African American and Hispanic people comprise 12% and 16%, respectively, of the U.S. population, they make up only 5% and 1%, respectively, of trial participants.

    Bond suggested a multitude of reasons for this disparity, including a lack of community engagement and an often negative perception of the healthcare industry.

    She encouraged investigators to adopt more flexible protocols, partner with trusted community voices, and collaborate with organizations such as the Association of Black Cardiologists and Women as One that are focused on closing disparities in clinical trials.

    Collaborating with community leaders could be a “key,” Bond said, to building trust and unlocking a diverse patient pool. 

    “We have to figure out better ways to really make sure that those within our trials reflect our overall country,” Bond said. The lack of diversity in clinical trials is “not just a scientific and medical issue, but more importantly, it’s a moral issue,” she added.

    “I would submit that intentional action is required by all,” Cigarroa said. “This is something that impacts all of our patients, that we all deal with.”

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