How AI in health care can help all, including Blacks now dying disproportionately from heart disease: Lee Kirksey

CLEVELAND — February is both American Heart Health and African American Heritage month, an opportunity to raise awareness around the No. 1 cause of death in Black Americans.

On two key metrics of overall population health — life expectancy and heart disease mortality — the state of Ohio ranks 38th and 40th, respectively. Heart disease which includes high blood pressure, heart attack, arrhythmias, valve abnormalities, and heart failure, is more prevalent in Black and Hispanic American communities as well as in lower-income communities across all races. Of note, once diagnosed, Black Americans are more likely to die of complications from heart conditions, compared to White Americans.

These alarming statistics notwithstanding, the rates of death from heart disease in all communities have declined over the past three decades. The effectiveness of available medications, innovation in surgical techniques and the evolution of less invasive medical devices allows many patients to experience excellent outcomes, once diagnosed. New data even confirm that, although outcome disparities between races persist in many types of cardiovascular care, implementing deliberate, systems-based protocols can effectively reduce historical differences in care at the time of a heart attack.

What are the opportunities to improve the seemingly impenetrable existence of race- and class-based disparities in health care that the Rev. Dr. Martin Luther King Jr. so appropriately described as the most shocking and inhumane form of inequality?

Recent advances in digital technologies represent the gateway to democratizing healthy personal behaviors.

Our recent Heart Health 2024 Survey reveals how Black Americans view technology and health. Over 75% of survey participants believe the information rendered by a computer chatbox is accurate. Importantly, 90% suggest that they would definitely check with their personal health care provider before acting on any chatbox recommendation.

Unfortunately, only 50% of respondents use some device or technology to monitor their health, suggesting that patients may not yet understand the immense potential of technology to enhance heart health. Those who have adopted “wearables” are, for the most part, using them to measure step count (60%) and pulse rate (53%). They are using technology much less to monitor key variables: sleep (33%) and blood pressure (32%).

The survey does provide evidence that digital technology enhances patient autonomy as it relates to chronic conditions, with Black Americans more likely (42%) than white Americans (29%) to track blood pressure or measure body fat composition (20% vs. 11%).

Why is health care system investment to sponsor a survey like this important? All too often, health care providers are inclined to assume that they understand what drives the behaviors of patients and communities. Asking the right questions, listening and sharing the findings are essential to effectively partnering with the communities that we serve.

From the patient perspective, consider the health care system where well-trained “digital” agents answer phones promptly, manage insurance claims/paperwork, medical questions and provide health care system navigation across the time, space and medical specialties of a large health care system. Or a doctor that looks you in the face during an office visit, freed up by an AI assistant which transcribes the note.

There is much upfront design and implementation work that must be done to allay understandable concerns harbored by communities of color. Health care algorithms (“deep learning”) are derived from the analysis of large patient data sets. However, when the body of searched information that yields the conclusion does not include sufficient representation of minority individuals, the computer-generated results may be biased. Current efforts are ongoing to identify and eliminate longstanding mathematical race bias from which machines learn. As they say in statistics, “Biased data input equals biased data output.”

Digital technology and AI represent the fourth industrial revolution and are here to stay. Our challenge is to identify the opportunities to responsibly introduce digital and AI solutions to encourage and reinforce healthy personal behaviors. Most importantly, we must do this across all communities, especially the most vulnerable. We must not perpetuate computerized structural racism in this new era.

Dr. Lee Kirksey is the Walter W. Buckley-endowed Vice Chair of Vascular Surgery at the Heart, Vascular and Thoracic Institute of the Cleveland Clinic and serves as the institute’s Chief Equity Community Engagement Officer. He is a native of Northeast Ohio and dedicated to population-based strategies to improve health in all communities.

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