Experts discuss racial bias in clinical algorithms, including efforts to remove race calculations. The podcast also covers the reliability of electronic health records and the inclusion of social determinants of health. Updates on the Omicron variant, vaccine effectiveness, and the impact of non-pharmaceutical interventions are included.
The American Heart Association has introduced a new cardiovascular disease risk calculator called Prevent, which addresses the limitations of previous calculators by incorporating recent reductions in risk factors and a larger and more diverse dataset.
Medical organizations are reevaluating the use of race as a factor in clinical decision-making algorithms, aiming to replace it with biomarkers, clinical factors, or social determinants of health to improve reliability across races and reduce health disparities in algorithm predictions.
Deep dives
New cardiovascular disease risk calculator
The American Heart Association (AHA) introduced a new cardiovascular disease (CVD) risk calculator called Prevent. This calculator addresses the limitations of the previous pooled cohort equations (PCEs) by reflecting recent reductions in CVD risk factors such as smoking, lipid levels, and anti-hypertensive medication use. Prevent utilizes a larger and more diverse dataset, including over 600,000 patients from research studies and electronic medical records. It eliminates separate calculations for black and white patients and expands the age group covered. Prevent includes heart failure as an outcome for the first time and incorporates measures of kidney and metabolic diseases. It is expected to replace the PCEs in practice guidelines over the next few years.
Reevaluating the use of race in clinical decision-making algorithms
Medical organizations are reevaluating the use of race as a factor in clinical decision-making algorithms. The Council of Medical Specialty Society's report highlights the harmful use of race as a proxy for biology and the potential for treatment differences. Efforts are underway to replace race with biomarkers, clinical factors, or social determinants of health in widely used algorithms. The American Academy of Pediatrics, for example, is reviewing its clinical guidelines and algorithms to eliminate race as a predictor. By incorporating more precise risk predictors based on social determinants of health, medical societies aim to improve the tools' reliability across races and reduce health disparities. The need to address this issue is critical as the healthcare industry increasingly relies on artificial intelligence and digital decision support tools.
Impact of the Omicron variant and considerations for respiratory infections
The Omicron variant, also known as JN1, has become the dominant variant of SARS-CoV-2. While highly contagious, it does not appear to cause more severe illness than previous variants. Vaccines targeting the XBB-1-5 variant still offer protection against severe disease and hospitalization. However, they do not fully prevent infection or mild to moderate illness. There has been a resurgence of other respiratory infections as well, attributed partly to the decline in non-pharmaceutical interventions and the delayed impact of delayed infections during the pandemic. Some researchers propose the concept of 'immunity debt' or 'immunity theft' to explain the increase in respiratory illnesses. The impacts of COVID-19 and the decline in pediatric vaccinations may contribute to surges in other viral infections, and additional research is needed to investigate these factors further.
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