AHA: More Clinical Education Needed on Appropriate Care for LGBTQ Patients

Cardiovascular (CV) health should be routinely assessed and addressed in lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) adults, according to a new American Heart Association (AHA) scientific statement published October 8, 2020 in the journal Circulation.

“This is particularly important now, at a time when there is increased awareness of health inequities related to unequal treatment and discrimination in the US,” said chair of the statement’s writing group Billy A. Caceres, PhD, RN, assistant professor, Columbia University School of Nursing, New York City, New York, in an AHA press release. “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.”

In terms of health, LGBTQ orientation is considered a “sexual minority,” and transgender or gender non-conforming is considered a “gender minority,” noted the press release.

LGBTQ populations face unique stressors including family rejection and anxiety over concealment of their sexual identity. Furthermore, LGBTQ adults in historically underrepresented racial or ethnic groups experience higher poverty levels, insecure housing, and fewer health care options vs their white LGBTQ peers, the press release noted.

Trust toward health care professionals is lacking among many members of the LGBTQ community as 56% of sexual minorities (ie, LGBTQ patients) and 70% of gender minority adults (ie, transgender or gender non-confirming) report having experienced some form of discrimination from a health care professional, according to the statement.

“It is paramount to include content about LGBTQ health in clinical training and licensure requirements in order to address these cardiovascular health disparities,” said Caceres in the press release.

Clinical training may be necessary, but accrediting bodies and organizations responsible for recommending curricular content (eg, Accreditation Council on Graduate Medical Education, Accreditation Review Commission on Education for the Physician Assistant), “provide little to no requirements for LGBTQ health content in the curricula,” said the writing committee.

The writing committee noted that although the Association of American Medical Colleges provided recommendations for LGBTQ health content, the Accreditation Review Commission on Education for the Physician Assistant began requiring LGBTQ curricular content in September 2020.

“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 in the press release.

The statement also noted that despite limited information specifically on the CV health of LGBTQ persons, a few risk factors stand out from existing data, and they identified the following areas that require LGBTQ-focused CV health efforts:

• Compared to cisgender heterosexual adults, LGBTQ adults are more likely to report tobacco use.
• Transgender adults had lower physical activity levels vs their cisgender counterparts, according to a systematic review. The statement suggests gender-affirming care might play a role in promoting physical activity among transgender people.
• Transgender women may be at increased risk for CV disease due to behavioral and clinical factors, such as the use of gender-affirming hormones like estrogen.
• Transgender women and non-binary persons are more likely to binge drink.
• Lesbian and bisexual women have a higher prevalence of obesity vs heterosexual women.

“There is much work to be done to understand and improve the cardiovascular health of LGBTQ adults,” concluded Caceres in the press release. “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.

The AHA statement is endorsed by the American Academy of Physician Assistants and the American Medical Association affirms the educational benefit of this document.