Disparities in Mitral Valve Disease Associated with Heart Failure

TL;DR

This paper reviews disparities in mitral valve disease linked to heart failure, showing how gender, race, and socioeconomic factors affect treatment and outcomes.

Contribution

The study highlights overlooked disparities in MVD treatment and outcomes across different demographic groups.

Findings

Women and Black patients face under-utilization and delayed treatment for MVD.

Low socioeconomic status increases risk for rheumatic heart disease and secondary mitral regurgitation.

Men and White patients experience fewer treatment inadequacies and better outcomes.

Abstract

Heart failure (HF) affects millions of people around the world and is a
prevalent health issue in the United States. In many cases, HF has an intricate
connection with mitral valvular disease (MVD), which can alter a patient’s
disease course. Factors such as gender, race, ethnicity, and social determinants
of health impact the prevalence, etiology, and treatment of MVD associated with
HF. This literature review examines the connection between MVD and HF among adult
patients, considering MVD as both a cause and an outcome of HF. This article also
identifies the differences in epidemiology and treatment of MVD associated with
HF across different gender, ethnicity, race, and socioeconomic groups. This is in
an effort to not only identify currently overlooked disparities but to highlight
potential ways to improve them. MVD was analyzed based on its hemodynamic
subtypes, mitral regurgitation (MR) and mitral stenosis (MS), as these subtypes
encompass different etiologies of MVD. The purpose of this article was to
identify broad disparities in MVD in association with HF in the adult population.
The results of this study found stark differences between prevalence, treatment,
and disease outcomes across groups. Women and Black patients were identified as
high-risk for under-utilization and prescription delay of treatment options.
Women were often treated at more advanced stages of MVD, while treatment was
often delayed in Black patient populations. Factors such as these impact
treatment outcomes. Conversely, men and White patients were identified as
lower-risk groups for treatment inadequacies and poor HF and MVD related
outcomes. Socioeconomic status (SES) was also found to play a role, with low SES
being a risk factor for developing rheumatic heart disease. Low SES groups are
also more likely to develop HF, which predisposes to secondary MR. Despite
general knowledge of these disparities, few studies analyze HF and MVD for
specific groups. This literature review is thus necessary to identify current
inequities in care and underscore potential solutions to raise awareness for
further research efforts and funding. This analysis identifies MVD treatment
guidelines and contributing social determinants of health as areas that must be
addressed to minimize HF and MVD disparities.

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