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American Heart Assoc.: Discrimination means poorer LGBTQ heart health

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DALLAS — Last week, the American Heart Association issued a scientific statement to address the effects of discrimination on LGBTQ heart health.

The AHA said in a press release that more than half (56%) of LGBTQ adults and 70% of transgender or non-conforming people experienced some form of discrimination from a healthcare profession. That includes the use of harsh or abusive language.

“This is particularly important now, at a time when there is increased awareness of health inequities related to unequal treatment and discrimination in the U.S.,” said Billy A. Caceres, Ph.D., R.N., FAHA, chair of the writing group for the statement and an assistant professor at the Columbia University School of Nursing in New York City. “LGBTQ individuals are delaying primary care and preventative visits because there is a great fear of being treated differently. Being treated differently often means receiving inadequate or inferior care because of sexual orientation or gender identity.”

The writing group noted trust toward health care professionals is still lacking among many members of the LGBTQ community, and health care professionals need more education on how to provide appropriate care for LGBTQ patients. Caceres said, “It is paramount to include content about LGBTQ health in clinical training and licensure requirements in order to address these cardiovascular health disparities.”

The AHA said that accrediting bodies don’t have specifically required LGBTQ-related content in their training. A 2018 online survey of students at 10 medical schools found approximately 80% of students did not feel competent to provide care for transgender patients. Another study of more than 800 physician residents across 120 internal medicine residencies in the U.S. found no difference in knowledge between the baseline and post-graduate years when it came to LGBTQ-specific health topics. The statement noted that the Accreditation Review Commission on Education for the Physician Assistant began requiring LGBTQ curricular content only this past September.

The AHA committee suggested that the assessment and documentation of sexual orientation and gender identity information in electronic health records could provide an opportunity to address specific health concerns for LGBTQ patients. They also noted that basic understanding of the terminology of LGBTQ identities is important. The statement includes a glossary to detail and clarify the various key words and terms used to describe members of the LGBTQ community such as bisexual, transgender, gay, gender nonbinary, etc.

“Health care systems need to play a significant role – to enact policies to encourage and support researchers and health care professionals to ask these questions in a respectful manner and to implement structures that emphasize the clinical importance of understanding the many layers related to caring for people with a minority sexual orientation or gender identity,” said Caceres.

The statement also notes that while there’s limited information on the cardiovascular health of LGBTQ people, a few risk factors stand out from existing data. They identify areas that require specific cardiovascular health efforts focused on the LGBTQ population:

  • LGBTQ adults are more likely to report tobacco use than their cisgender heterosexual peers.
  • Transgender adults had lower physical activity levels than their cisgender counterparts, according to a systematic review.

The AHA said that future research is needed for the entire LGBTQ community to understand the stressors that can affect heart health and develop better treatment. That includes diving into the different segments in the community because most studies up to now have usually used white, educated LGBTQ adults.

“There is much work to be done to understand and improve the cardiovascular health of LGBTQ adults,” Caceres said. “We need more robust research that allows us to draw stronger conclusions, as well as initiatives to increase clinicians’ knowledge, thereby improving care and health outcomes for LGBTQ adults.”

You can read the full Scientific Statement here. It is the AHA’s first statement to address LGBTQ health.

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