Addressing cardiovascular health disparities: global perspectives from the patient community

Cardiovascular diseases (CVDs) continue to be the leading cause of death globally, imposing substantial costs on health-care systems.¹ A new Series on inequalities and disparities in cardiovascular health in The Lancet Regional Health–Europe underscores persistent disparities in cardiovascular outcomes among key populations—including women, ethnic minorities, the elderly, and those with mental health conditions—and offers expert recommendations for achieving equitable and integrated care.2, 3, 4, 5 Global Heart Hub (GHH), an international alliance of heart patient organisations, welcomes this Series and endorses the call for equity-driven action to overcome the inequities across the entire care pathway in CVD. In recent years, GHH has convened international Patient Summits to capture real-world patient experiences of barriers to early detection, diagnosis, and equitable care in CVD, especially among women and people living with multiple connected conditions. This Comment highlights some of their stories, which validate this evidence and underscore the urgency and relevance of this work.

Our community can bear testimony to the impact of geographic, financial, social, and commercial determinants of health on people living with or affected by CVD. Systemic obstacles such as restricted access to health care and biases across age, sex, race, and ethnicity worsen CVD risk management and hinder care for high-risk groups. Anu Gomanju, who lives with rheumatic heart disease and underwent open-heart surgery at age 11 to repair a heart valve, recalls how some people questioned her father’s decision to invest in her treatment, saying they would only do so for a son. The nearest hospital is around an hour’s drive from her home in Nepal, adding to the challenges of accessing care. She reflects on the broader toll of CVD: “I wish for meaningful engagement with patients to understand how they perceive their health and heart conditions, so they can find solutions that best suit their lifestyles and cultures”. Health-care systems need to prioritise culturally appropriate and inclusive care, which is responsive to the unique needs of communities.

Success in reducing fundamental CVD risk heavily depends on how culturally applicable and accessible preventive measures like physical exercise, smoking cessation, and healthy diet are. Public health strategies must prioritise early detection, early diagnosis, and equitable access to timely and appropriate care, especially within primary care and community settings. Protective therapies and disease management models can be effectively implemented when common cardiovascular risk factors, such as high cholesterol, high blood pressure, or atrial fibrillation, as well as conditions like heart failure or heart valve disease, are detected early. GHH has co-developed, in collaboration with diverse stakeholders, a manifesto for the early detection and diagnosis of CVD. It outlines key actions for success, such as redesigning care pathways, leveraging digital technologies, and strengthening workforce training and capacity.⁶

Emerging research continues to underscore crucial gaps across care pathways in global health: CVD in women remains significantly understudied, under-recognised, underdiagnosed, and undertreated.^2,7 Consequential gaps in evidence-based guidelines and treatment protocols perpetuate disparities in patient outcomes. Catherine Goodenough, from Canada, was diagnosed with coronary microvascular dysfunction after a 2-year journey of dismissed symptoms. She recalls: “Even when you have an episode and end up in the emergency room, they don’t believe you—your blood tests are normal, so they send you home saying it’s probably stress or anxiety.” Addressing biases through inclusive research practices—representing women,² older adults,⁴ and people from ethnic minorities³—and disaggregated data collection are imperative.

The relationship between mental health and cardiovascular outcomes is well established and often bidirectional.⁵ Integrated care models that address both physical and psychological health have demonstrated efficacy and should be expanded. Despite the robust evidence, guideline recommendations, and psychological benefits experienced by patients undergoing cardiac rehabilitation, referral, and access remain sub-optimal. Michael Uchunor from Nigeria was living with years of unmanaged hypertension when he suffered a stroke at age 33. In Michael’s experience, “paying out-of-pocket for medications, physiotherapy, and speech therapy took a heavy toll”.

Equally, given that people living with multiple chronic conditions have a higher risk of death than those without,⁸ low patient awareness of the interconnectedness of CVDs is a barrier to optimal self-care and management. As someone living with multiple chronic conditions, Michael shares: “Clinicians must recognise that caring for people like me is about ‘whole person health’: restoring wellbeing, promoting resilience, and preventing disease across the lifespan.”

Tackling disparities in CVDs is not only a clinical imperative, but also a moral responsibility demanding collective action. GHH and its affiliates are working with stakeholders worldwide to advance early screening, timely diagnosis, equitable access to treatment and rehabilitation, and, crucially, to ensure patients are included in these conversations and solutions. The value of lived experience and patient-reported data is indisputable, and the global CVD patient community stands ready to help shape and support equity-driven action.

Contributors

Karen Padilla Cabrera did the literature search, interviews with patients, and commentary writing. Neil Johnson did commentary writing, review, and editing.

Declaration of interests

We declare no competing interests.