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The Implementation Frontier: Impact on Cardiovascular Health in Racial and Ethnic Minority Populations

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Cardiovascular Disease in Racial and Ethnic Minority Populations

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Research advances in the prevention, detection, evaluation, and treatment of cardiovascular disease have contributed to the remarkable declines in cardiovascular mortality rates observed over the last half century. Although these improvements have been seen in both men and women and in all racial and ethnic groups at the national level, important differences exist at the sub-national level, especially for population groups defined by race, ethnicity, gender, geography, income, education, and other social and environmental determinants of health. Recent evidence suggests that cardiovascular health disparities remain pervasive. The reasons for these disparities are numerous and include unequal treatment and other important differences in the quality of healthcare delivered to different racial, ethnic, and socioeconomic groups. Impediments to the sustained delivery of evidence-based practices constitute an “implementation frontier” characterized by the underuse of high-value, evidence-based interventions, as well as the overuse of ineffective or low-value interventions—a scenario characterized as a “double jeopardy” often seen in African American and Hispanic populations. This chapter reviews the challenges inherent in the implementation frontier and proposes a framework for exploring strategies to address these challenges. Selected examples used to demonstrate challenges at the frontier include the treatment and control of hypertension; referrals for cardiac catheterization and invasive coronary procedures; utilization and outcomes of structural heart disease interventions; prevention and treatment of heart failure; and anticoagulation for the primary and secondary prevention of ischemic stroke in atrial fibrillation. This chapter concludes with the role that implementors can play in addressing the implementation frontier challenges and the implications for clinical practice and research.

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References

  1. Mensah GA, Wei GS, Sorlie PD, et al. Decline in Cardiovascular Mortality: Possible Causes and Implications. Circ Res. 2017;120(2):366–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Centers for Disease Control and Prevention. Achievements in Public Health, 1900–1999: Decline in Deaths from Heart Disease and Stroke – United States, 1900–1999. MMWR Morb Mortal Wkly Rep. 1999;48(30):649–656.

    Google Scholar 

  3. National Center for Health Statistics. Health, United States. 2017: with special feature on mortality. Hyattsville, MD: U.S. Department of Health and Human Services; 2018.

    Google Scholar 

  4. Murray CJ, Kulkarni SC, Michaud C, et al. Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States. PLoS Med. 2006;3(9):e260.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Institute of Medicine. Unequal treatment: confronting racial and ethnic disparities in health care. National Academies Press; 2003.

    Google Scholar 

  6. Agency for Healthcare Research and Quality. 2017 National healthcare quality and disparities report, September, 2018. AHRQ Pub. No. 18-0033-EF. Rockville: AHRQ; 2018.

    Google Scholar 

  7. Schpero WL, Morden NE, Sequist TD, Rosenthal MB, Gottlieb DJ, Colla CH. For selected services, blacks and hispanics more likely to receive low-value care than whites. Health Aff (Millwood). 2017;36(6):1065–9.

    Article  Google Scholar 

  8. Kressin NR, Groeneveld PW. Race/ethnicity and overuse of care: a systematic review. Milbank Q. 2015;93(1):112–38.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Mensah GA, Boyce CA, Price LN, Mishoe HO, Engelgau MM. Perspective: late-stage (T4) translation research and implementation science: the National Heart, Lung, and Blood Institute strategic vision. Ethn Dis. 2017;27(4):367–70.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Balas EA, Boren SA. Managing clinical knowledge for health care improvement. In: Bemmel J, McCray AT, editors. Yearbook of medical informatics 2000: patient-centered systems. Stuttgart, Germany: Schattauer Verlagsgesellschaft mbH; 2000. p. 65–70.

    Google Scholar 

  11. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635–45.

    Article  PubMed  Google Scholar 

  12. Levine DM, Linder JA, Landon BE. The quality of outpatient care delivered to adults in the United States, 2002 to 2013. JAMA Int Med. 2016;176(12):1778–90.

    Article  Google Scholar 

  13. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017;18(1):19.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Green AR, Carney DR, Pallin DJ, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007;22(9):1231–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lukachko A, Hatzenbuehler ML, Keyes KM. Structural racism and myocardial infarction in the United States. Soc Sci Med. 2014;103:42–50.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Pallok K, De Maio F, Ansell DA. Structural racism – a 60-year-old black woman with breast cancer. N Engl J Med. 2019;380(16):1489–93.

    Article  PubMed  Google Scholar 

  17. Whittington MD, Ho PM, Helfrich CD. Recommendations for the use of audit and feedback to de-implement low-value care. Am J Med Qual. 2019;1062860618824153

    Google Scholar 

  18. Helfrich CD, Hartmann CW, Parikh TJ, Au DH. Promoting health equity through de-implementation research. Ethn Dis. 2019;29(Suppl 1):93–6.

    Article  PubMed  PubMed Central  Google Scholar 

  19. McKay VR, Morshed AB, Brownson RC, Proctor EK, Prusaczyk B. Letting go: conceptualizing intervention de-implementation in public health and social service settings. Am J Community Psychol. 2018;

    Google Scholar 

  20. Davidson KW, Ye S, Mensah GA. Commentary: De-implementation science: a virtuous cycle of ceasing and desisting low-value care before implementing new high value care. Ethn Dis. 2017;27(4):463–8.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Prasad V, Ioannidis JP. Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices. Implement Sci. 2014;9(1):1–9. https://doi.org/10.1186/1748-5908-9-1.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Glasgow RE, McKay HG, Piette JD, Reynolds KD. The RE-AIM framework for evaluating interventions: what can it tell us about approaches to chronic illness management? Patient Educ Couns. 2001;44(2):119–27.

    Article  CAS  PubMed  Google Scholar 

  23. O’Gara PT, Oetgen WJ. Innovation and implementation in cardiovascular medicine: challenges in the face of opportunity. JAMA. 2015;313(10):1007–8.

    Article  PubMed  Google Scholar 

  24. Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Admin Pol Ment Health. 2011;38(2):65–76.

    Article  Google Scholar 

  25. Burt VL, Cutler JA, Higgins M, et al. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991. Hypertension. 1995;26(1):60–9.

    Article  CAS  PubMed  Google Scholar 

  26. Fryar CD, Ostchega Y, Hales CM, Zhang G, Kruszon-Moran D. Hypertension prevalence and control among adults: United States, 2015–2016. NCHS Data Brief. 2017;(289):1–8.

    Google Scholar 

  27. Sripipatana A, Pourat N, Chen X, Zhou W, Lu C. Exploring racial/ethnic disparities in hypertension care among patients served by health centers in the United States. J Clin Hyper (Greenwich, Conn). 2019;21(4):489–98.

    Article  Google Scholar 

  28. Victor RG, Lynch K, Li N, et al. A cluster-randomized trial of blood-pressure reduction in black barbershops. N Engl J Med. 2018;378(14):1291–301.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Jaffe MG, Young JD. The Kaiser Permanente Northern California story: improving hypertension control from 44% to 90% in 13 years (2000 to 2013). J Clin Hyper (Greenwich, Conn). 2016;18(4):260–1.

    Article  Google Scholar 

  30. Sim JJ, Handler J, Jacobsen SJ, Kanter MH. Systemic implementation strategies to improve hypertension: the Kaiser Permanente Southern California experience. Can J Cardiol. 2014;30(5):544–52.

    Article  PubMed  Google Scholar 

  31. Dorans KS, Mills KT, Liu Y, He J. Trends in prevalence and control of hypertension according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline. J Am Heart Assoc. 2018;7(11)

    Google Scholar 

  32. Benjamin EJ, Muntner P, Alonso A, et al. heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56–e528.

    Article  PubMed  Google Scholar 

  33. Fletcher R, Maron D, Jones R, et al. Better blood pressure control among white than black veteran patients from 2000 to 2014. J Am Coll Cardiol. 2019;73(9 Suppl 1):1822.

    Article  Google Scholar 

  34. Ayanian JZ, Landon BE, Newhouse JP, Zaslavsky AM. Racial and ethnic disparities among enrollees in medicare advantage plans. N Engl J Med. 2014;371(24):2288–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Lillie-Blanton M, Maddox TM, Rushing O, Mensah GA. Disparities in cardiac care: rising to the challenge of Healthy People 2010. J Am Coll Cardiol. 2004;44(3):503–8.

    Article  PubMed  Google Scholar 

  36. Lillie-Blanton M, Rushing OE, Ruiz S, Mayberry R, Boone L. Racial/ethnic differences in cardiac care: the weight of the evidence. Washington, DC: Henry J Kaiser Family Foundation; 2004.

    Google Scholar 

  37. Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340(8):618–26.

    Article  CAS  PubMed  Google Scholar 

  38. Ayanian JZ. Determinants of racial and ethnic disparities in surgical care. World J Surg. 2008;32(4):509–15.

    Article  PubMed  Google Scholar 

  39. Schneider EC, Leape LL, Weissman JS, Piana RN, Gatsonis C, Epstein AM. Racial differences in cardiac revascularization rates: does “overuse” explain higher rates among white patients? Ann Intern Med. 2001;135(5):328–37.

    Article  CAS  PubMed  Google Scholar 

  40. Bolorunduro OB, Kiladejo AV, Animashaun IB, Akinboboye OO. Disparities in revascularization after ST elevation myocardial infarction (STEMI) before and after the 2002 IOM report. J Natl Med Assoc. 2016;108(2):119–23.

    PubMed  Google Scholar 

  41. Hannan EL, Racz MJ, Walford G, et al. Disparities in the use of drug-eluting coronary stents by race, ethnicity, payer, and hospital. Can J Cardiol. 2016;32(8):e925–31.

    Article  Google Scholar 

  42. Mohamad T, Panaich SS, Alani A, et al. Racial disparities in left main stenting: insights from a real world inner city population. J Interv Cardiol. 2013;26(1):43–8.

    Article  PubMed  Google Scholar 

  43. Freund KM, Jacobs AK, Pechacek JA, White HF, Ash AS. Disparities by race, ethnicity, and sex in treating acute coronary syndromes. J Women’s Health. 2002;21(2):126–32.

    Article  Google Scholar 

  44. Gaglia MA Jr, Steinberg DH, Pinto Slottow TL, et al. Racial disparities in outcomes following percutaneous coronary intervention with drug-eluting stents. Am J Cardiol. 2009;103(5):653–8.

    Article  CAS  PubMed  Google Scholar 

  45. Bonaa KH, Mannsverk J, Wiseth R, et al. Drug-eluting or bare-metal stents for coronary artery disease. N Engl J Med. 2016;375(13):1242–52.

    Article  CAS  PubMed  Google Scholar 

  46. Alkhouli M, Alqahtani F, Holmes DR, Berzingi C. Racial disparities in the utilization and outcomes of structural heart disease interventions in the united states. J Am Heart Assoc. 2019;8(15):e012125.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Van Nuys KE, Xie Z, Tysinger B, Hlatky MA, Goldman DP. Innovation in heart failure treatment: life expectancy, disability, and health disparities. JACC Heart failure. 2018;6(5):401–9.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Lee WC, Serag H, Ohsfeldt RL, et al. Racial disparities in type of heart failure and hospitalization. J Immigr Minor Health. 2019;21(1):98–104.

    Article  PubMed  Google Scholar 

  49. Casper M, Nwaise I, Croft JB, Hong Y, Fang J, Greer S. Geographic disparities in heart failure hospitalization rates among medicare beneficiaries. J Am Coll Cardiol. 2010;55(4):294–9.

    Article  PubMed  Google Scholar 

  50. Dupre ME, Gu D, Xu H, Willis J, Curtis LH, Peterson ED. Racial and ethnic differences in trajectories of hospitalization in US men and women with heart failure. J Am Heart Assoc. 2017;6(11)

    Google Scholar 

  51. Selim AM, Mazurek JA, Iqbal M, Wang D, Negassa A, Zolty R. Mortality and readmission rates in patients hospitalized for acute decompensated heart failure: a comparison between cardiology and general-medicine service outcomes in an underserved population. Clin Cardiol. 2015;38(3):131–8.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Uthamalingam S, Kandala J, Selvaraj V, et al. Outcomes of patients with acute decompensated heart failure managed by cardiologists versus noncardiologists. Am J Cardiol. 2015;115(4):466–71.

    Article  PubMed  Google Scholar 

  53. Kociol RD, Hammill BG, Fonarow GC, et al. Associations between use of the hospitalist model and quality of care and outcomes of older patients hospitalized for heart failure. JACC Heart Failure. 2013;1(5):445–53.

    Article  PubMed  Google Scholar 

  54. Auerbach AD, Hamel MB, Califf RM, et al. Patient characteristics associated with care by a cardiologist among adults hospitalized with severe congestive heart failure. SUPPORT investigators. Study to understand prognoses and preferences for outcomes and risks of treatments. J Am Coll Cardiol. 2000;36(7):2119–25.

    Article  CAS  PubMed  Google Scholar 

  55. Breathett K, Liu WG, Allen LA, et al. African Americans are less likely to receive care by a cardiologist during an intensive care unit admission for Heart failure. JACC Heart Failure. 2018;6(5):413–20.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Lampropulos JF, Kim N, Wang Y, et al. Trends in left ventricular assist device use and outcomes among Medicare beneficiaries, 2004–2011. Open Heart. 2014;1(1):e000109.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Joyce DL, Conte JV, Russell SD, Joyce LD, Chang DC. Disparities in access to left ventricular assist device therapy. J Surg Res. 2009;152(1):111–7.

    Article  PubMed  Google Scholar 

  58. Sridhar AR, Yarlagadda V, Parasa S, et al. Cardiac resynchronization therapy: US trends and disparities in utilization and outcomes. Circ Arrhythm Electrophysiol. 2016;9(3):e003108.

    Article  PubMed  Google Scholar 

  59. Farmer SA, Kirkpatrick JN, Heidenreich PA, Curtis JP, Wang Y, Groeneveld PW. Ethnic and racial disparities in cardiac resynchronization therapy. Heart Rhythm. 2009;6(3):325–31.

    Article  PubMed  Google Scholar 

  60. January CT, Wann LS, Calkins H, et al. AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(1):104–32.

    Article  PubMed  Google Scholar 

  61. Birman-Deych E, Radford MJ, Nilasena DS, Gage BF. Use and effectiveness of warfarin in Medicare beneficiaries with atrial fibrillation. Stroke. 2006;37(4):1070–4.

    Article  CAS  PubMed  Google Scholar 

  62. Shen AY, Yao JF, Brar SS, Jorgensen MB, Wang X, Chen W. Racial/ethnic differences in ischemic stroke rates and the efficacy of warfarin among patients with atrial fibrillation. Stroke. 2008;39(10):2736–43.

    Article  CAS  PubMed  Google Scholar 

  63. Essien UR, Holmes DN, Jackson LR 2nd, et al. Association of race/ethnicity with oral anticoagulant use in patients with atrial fibrillation: findings from the outcomes registry for better informed treatment of atrial fibrillation II. JAMA Cardiol. 2018;

    Google Scholar 

  64. Sur NB, Wang K, Di Tullio MR, et al. Disparities and temporal trends in the use of anticoagulation in patients with ischemic stroke and atrial fibrillation. Stroke. 2019;50(6):1452–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Institute of Medicine. Clinical practice guidelines we can trust. Washington, DC: National Academy Press; 2013.

    Google Scholar 

  66. Chan WV, Pearson TA, Bennett GC, et al. ACC/AHA special report: clinical practice guideline implementation strategies: a summary of systematic reviews by the NHLBI Implementation Science Work Group: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;69(8):1076–92.

    Article  PubMed  Google Scholar 

  67. Zeidan AJ, Khatri UG, Aysola J, et al. Implicit Bias education and emergency medicine training: step one? Awareness. AEM Educ Train. 2019;3(1):81–5.

    Article  PubMed  Google Scholar 

  68. Gonzalez CM, Kim MY, Marantz PR. Implicit bias and its relation to health disparities: a teaching program and survey of medical students. Teach Learn Med. 2014;26(1):64–71.

    Article  PubMed  Google Scholar 

  69. Karcher R, Berman AE, Gross H, et al. Addressing disparities in stroke prevention for atrial fibrillation: educational opportunities. Am J Med Qual. 2016;31(4):337–48.

    Article  PubMed  Google Scholar 

  70. Beach MC, Cooper LA, Robinson KA, et al. Strategies for improving minority healthcare quality. Summary, evidence report/technology assessment no. 90. (prepared by the Johns Hopkins University Evidencebased practice center, Baltimore, MD). AHRQ publication no. 04-E008–01. Agency for Healthcare Research and Quality: Rockville; 2004.

    Google Scholar 

  71. Spivack SB, Bernheim SM, Forman HP, Drye EE, Krumholz HM. Hospital cardiovascular outcome measures in federal pay-for-reporting and pay-for-performance programs: a brief overview of current efforts. Circulation Cardiovascular Quality and Outcomes. 2014;7(5):627–33.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Kaplan CM, Thompson MP, Waters TM. How have 30-day readmission penalties affected racial disparities in readmissions?: an analysis from 2007 to 2014 in five US States. J Gen Intern Med. 2019;34(6):878–83.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Joynt Maddox KE, Reidhead M, Hu J, et al. Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program. Health Serv Res. 2019;54(2):327–36.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Gaskin DJ, Zare H, Delarmente BA. The supply of hospital care to minority and low-income communities and the hospital readmission reduction program. Med Care Res Rev. 2019:1077558719861242.

    Google Scholar 

  75. Gaskin DJ, Zare H, Vazin R, Love D, Steinwachs D. Racial and ethnic composition of hospitals’ service areas and the likelihood of being penalized for excess readmissions by the medicare program. Med Care. 2018;56(11):934–43.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Figueroa JF, Zheng J, Orav EJ, Epstein AM, Jha AK. Medicare program associated with narrowing hospital readmission disparities between black and white patients. Health Aff (Millwood). 2018;37(4):654–61.

    Article  Google Scholar 

  77. Chaiyachati KH, Qi M, Werner RM. Changes to racial disparities in readmission rates after medicare’s hospital readmissions reduction program within safety-net and non-safety-net hospitals. JAMA Netw Open. 2018;1(7):e184154.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Hawn MT. Unintended consequences of the hospital readmission reduction program. Ann Surg. 2015;261(6):1032–3.

    Article  PubMed  Google Scholar 

  79. Rubin R. How value-based medicare payments exacerbate health care disparities. JAMA. 2018;319(10):968–70.

    Article  PubMed  Google Scholar 

  80. Joynt Maddox KE. Financial incentives and vulnerable populations – will alternative payment models help or hurt? N Engl J Med. 2018;378(11):977–9.

    Article  PubMed  Google Scholar 

  81. Morgan DJ, Brownlee S, Leppin AL, et al. Setting a research agenda for medical overuse. BMJ. 2015;351:h4534.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Mensah GA. Embracing dissemination and implementation research in cardiac critical care. Glob Heart. 2014;9(4):363–6.

    Article  PubMed  Google Scholar 

  83. Mensah GA, Stoney CM, Freemer MM, et al. The National Heart, Lung, and Blood Institute strategic vision implementation for health equity research. Ethn Dis. 2019;29(Suppl 1):57–64.

    Article  PubMed  PubMed Central  Google Scholar 

  84. Norton WE, Kennedy AE, Chambers DA. Studying de-implementation in health: an analysis of funded research grants. Implementation Sci IS. 2017;12(1):144.

    Article  PubMed  Google Scholar 

  85. Perez-Stable EJ, Collins FS. Science visioning in minority health and health disparities. Am J Public Health. 2019;109(S1):S5.

    Article  PubMed  PubMed Central  Google Scholar 

  86. Yancy CW, Wang TY, Ventura HO, et al. The coalition to reduce racial and ethnic disparities in cardiovascular disease outcomes (credo): why credo matters to cardiologists. J Am Coll Cardiol. 2011;57(3):245–52.

    Article  PubMed  Google Scholar 

  87. Betancourt JR, Tan-McGrory A, Kenst KS, Phan TH, Lopez L. Organizational change management for health equity: perspectives from the disparities leadership program. Health Aff (Millwood). 2017;36(6):1095–101.

    Article  Google Scholar 

  88. Hisam B, Zogg CK, Chaudhary MA, et al. From understanding to action: interventions for surgical disparities. J Surg Res. 2016;200(2):560–78.

    Article  PubMed  Google Scholar 

  89. Cohen MG, Fonarow GC, Peterson ED, et al. Racial and ethnic differences in the treatment of acute myocardial infarction: findings from the Get With the Guidelines-Coronary Artery Disease program. Circulation. 2010;121(21):2294–301.

    Article  PubMed  Google Scholar 

  90. National Heart, Lung, and Blood Institute. Charting the Future Together: The NHLBI Strategic Vision. 2016. https://www.nhlbi.nih.gov/sites/default/files/2017-11/NHLBI-Strategic-Vision-2016_FF.pdf. Accessed 16 May 2021.

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The views expressed in this chapter are those of the author and do not necessarily represent the views of the National Heart, Lung, and Blood Institute, the National Institutes of Health, or the United States Department of Health and Human Services.

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  1. Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA

    George A. Mensah

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  1. Tulane University School of Medicine, New Orleans, LA, USA

    Keith C. Ferdinand

  2. Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA, USA

    Herman A. Taylor, Jr.

  3. School of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA

    Carlos J. Rodriguez

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Mensah, G.A. (2021). The Implementation Frontier: Impact on Cardiovascular Health in Racial and Ethnic Minority Populations. In: Ferdinand, K.C., Taylor, Jr., H.A., Rodriguez, C.J. (eds) Cardiovascular Disease in Racial and Ethnic Minority Populations. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-030-81034-4_5

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