Partnership Programs for Reducing Cardiovascular Disparities in Native Hawaiians
Condition: Cardiovascular Diseases; Heart Diseases
MeSH terms: Cardiovascular Diseases; Heart Diseases
Study type: Observational

Summary: 
      The purpose of this study is to improve cardiovascular disease (CVD) outcomes in racial and
      ethnic minorities in Hawaii.
    

Detailed description: 
      BACKGROUND:

      While there has been great progress in reducing CVD morbidity and mortality in the U.S. over
      the past 40 years, some minority groups have not benefitted from this progress, and continue
      to have lower life expectancy and higher CVD morbidity. On average, minorities have more
      limited access to medical care, receive less aggressive care, and receive fewer diagnostic
      and therapeutic cardiac procedures than non-minority populations. Additionally, most minority
      groups adhere poorly to prescribed medical regimens and often present to emergency
      departments rather than primary care physicians for complications of advanced chronic CVD
      conditions. Thus, research to reduce health disparities by improving CVD outcomes in
      minorities offers potential for a substantial positive impact on public health. Academic
      medical centers and institutions that are capable of carrying out such research, however,
      often lack access to minority patients and have difficulty gaining the trust of those they
      are able to treat. Minority communities often report greater satisfaction when receiving care
      from minority providers and are reluctant to receive treatment outside their minority
      healthcare serving systems.

      In general, minorities have high rates of elevated cholesterol, hypertension, cigarette
      smoking, obesity, metabolic syndrome, and diabetes. Other behavioral, environmental, and
      occupational risk factors for cardiovascular diseases, such as sleep problems are also common
      among minorties. These risk factors all contribute to excess CVD morbidity and mortality.
      Heart failure (HF) is also a major public health problem. The impact of HF on minority
      populations, such as Native Hawaiians and other Pacific peoples, is unknown. Native Hawaiians
      are known to have high rates of risk factors for HF and one of the highest rates of CVD
      mortality in the U.S. The causes of minority health disparities are complex and are not
      understood completely. Although evidence of genetic, biologic, and environmental factors is
      well documented, poor outcomes are also attributed to incomplete treatment. Such treatment
      may be due to limited access to health care or, in some cases, break-down of the medical
      system or failure of the physician and/or patient to allow for optimal health care, even when
      access is not impaired. The complex interactions of behavior, socio-economic status (SES),
      culture, and ethnicity are important predictors of health outcomes and sources of health
      disparities. Despite efforts to elucidate genetic and environmental risk factors and to
      promote cardiovascular health in high-risk populations, trends in CVD outcomes suggest that
      CVD health disparities continue to widen.

      The Partnerships Program to Reduce Cardiovascular Health Disparities involves collaboration
      between research-intensive medical centers (RIMCs) that have a track record of NIH-supported
      research and patient care and minority healthcare serving systems (MSSs) that lack a strong
      research program. Each Partnership Program will design and carry out multiple
      interdisciplinary research projects that investigate complex biologic, behavioral, and
      societal factors that contribute to CVD health disparities and facilitate clinical research
      within the MSS. The aim will be to improve CVD outcomes and reduce health disparities.
      Additionally, each program will provide reciprocal educational and skills development
      programs to train investigators to conduct research that is aimed at reducing cardiovascular
      disparities, thereby enhancing research opportunities and enriching cultural sensitivity and
      cardiovascular research capabilities at both institutions.

      The Request for Applications for Partnership Programs to Reduce Cardiovascular Disparities
      was released in September, 2003. The awards were made in September, 2004.

      DESIGN NARRATIVE:

      To address heart failure disparities among native Hawaiians and Pacific peoples, a
      partnership program, the HF Disparities Program (HFD), will be established between the Queen
      Emma Clinic (QEC) and the Department of Native Hawaiian Health. Partners of the HFD Program
      include tha following: MedStar Research Institute, Oahu-based Community Health Centers
      (CHCs), and the Hawaii EXPORT Center, an NIH-funded initiative addressing diabetes-associated
      disparities in native Hawaiians and Pacific peoples. The HFD Program will address the
      following aims: determine the reliability and validity of echocardiograms performed by
      community-based health workers compared to a professionally trained sonographer as the "gold
      standard"; determine if a culturally competent educational program for heart failure reduces
      HF hospitalizations and mortality compared to usual care; characterize ethnic differences in
      the HF syndrome in hospitalized native Hawaiians and Pacific peoples compared to Caucasians;
      construct HF pedigrees using probands identified at the Queen Emma Clinic for a future HF
      linkage study in native Hawaiians and Pacific peoples; educate community-based health workers
      to perform echocardiography scans for the detection of HF in a high risk population of native
      Hawaiians and Pacific peoples; and train new investigators to conduct research focused on CVD
      disparities in general, and HF in particular. By achieving these aims, the HFD Program will
      improve access to HF care at Community Health Centers that serve native Hawaiians and Pacific
      peoples, fill a gap in knowledge of CVD disparities in native Hawaiians and Pacific peoples,
      and provide a foundation for future studies on genetic determinants of HF.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Participants will be a Native Hawaiian or Pacific Islander (e.g., Samoan, Tongan, Tahitian,
        Maori, Marshallese, etc.)
      
Keywords: Heart Failure