To improve cardiovascular disease (CVD) outcomes in racial and ethnic minorities.

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 shared fully in this progress and continue to have lower life expectancy and higher CVD morbidity. On average, minorities have less access to medical care, receive less aggressive care and fewer diagnostic and therapeutic cardiac procedures, and adhere poorly to prescribed medical regimens. Thus, research to reduce health disparities by improving CVD outcomes in minorities offers potential for a substantial positive public heath impact. Academic medical centers and institutions capable of carrying out such research, however, often lack access to and the trust of minority patients. Minority patients often receive fragmented care because they lack access to regular medical care, present to emergency departments rather than primary care physicians for complications of an advanced chronic CVD condition, and are less likely to follow medical regimens. Minority communities often harbor distrust of clinical research. Minority patients 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 hypertension, elevated cholesterol, cigarette smoking, obesity, metabolic syndrome, and diabetes, as well as other behavioral, environmental, and occupational risk factors for cardiovascular diseases, such as sleep problems - all elements that contribute to excess CVD morbidity and mortality. The causes of minority health disparities are complex and incompletely understood. Although evidence of genetic, biologic, and environmental factors is well documented, poor outcomes are also attributed to under-treatment. Such under-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: a) design and carry out multiple interdisciplinary research projects that investigate complex biological, behavioral and societal factors that contribute to CVD health disparities and facilitate clinical research within the MSS to improve CVD outcomes and reduce health disparities, and b) provide reciprocal educational and skills development programs to develop investigators able to conduct research aimed to reduce cardiovascular disparities and thereby enhance research opportunities, enrich cultural sensitivity and cardiovascular research capabilities at both institutions.

Heart failure (HF) is a major public health problem leading to considerable cardiovascular morbidity and mortality. The impact of HF on minority populations, such as Native Hawaiians (NHs) and other Pacific Peoples (PPs), is unknown. Native Hawaiians are known to have high rates of risk factors for HF and one of the highest rates of cardiovascular disease (CVD) mortality in the U.S. Access to appropriate care is known to improve health outcomes for HF patients, but access to specialist care presents a major barrier for Native Hawaiians & Pacific Peoples because they tend to reside in medically underserved areas

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 NH Health. Partners of the HFD Program include: MedStar Research Institute, Oahu-based Community Health Centers (CHCs) & the Hawaii EXPORT Center, an NIH-funded initiative addressing diabetes-associated disparities in Native Hawaiians/Pacific Peoples. The Heart Failure Disparities Program will achieve the following research & educational aims: 1) Determine the reliability & validity of echocardiograms performed by community-based health workers compared to a professionally trained sonographer as the "gold standard". 2) Determine if a culturally competent educational program for heart failure reduces heart failure hospitalizations & mortality compared to usual care. 3) Characterize ethnic differences in the heart failure syndrome in hospitalized Native Hawaiians & Pacific Peoples compared to Caucasians. 4) Construct heart failure pedigrees using probands identified at the Queen Emma Clinic for a future heart failure linkage study in Native Hawaiians & Pacific Peoples. 5) Educate community-based health workers to perform echocardiography scans for the detection of heart failure in a high risk population of Native Hawaiians & Pacific Peoples. 6) Train new investigators to conduct research focused on CVD disparities in general, and heart failure in particular. By achieving these aims, the Heart Failure Disparities Program will improve access to heart failure care at Community Health Centers that serve Native Hawaiians & Pacific Peoples, fill a gap in knowledge of CVD disparities in Native Hawaiians & Pacific Peoples and provide a foundation for future studies on genetic determinants of heart failure.

Ages Eligible for Study:  21 Years   -   90 Years,  Genders Eligible for Study:  Both

Criteria