Optimizing Care for Cardiovascular-Kidney-Metabolic Syndrome: Leveraging Implementation Science in the Path Toward Pharmacoequity

Abstract

Purpose of review: Overview the current landscape of pharmacoequity in cardiovascular-kidney-metabolic (CKM) syndrome.

Recent findings: CKM syndrome is a key driver of the significant morbidity and mortality associated with cardiovascular disease, and poses a significant threat to public health. Despite a growing armamentarium of evidence-based therapies for the prevention and management of CKM syndrome, access to these treatments remains unequal. For instance, gender, race, and ethnicity-based disparities have been noted in use of first-line, guideline-directed, disease-modifying drugs. Barriers to pharmacoequity in CKM including multimorbidity/polypharmacy, low awareness, clinical inertia, cost, pharmacy inaccessibility, unequal socio-contextual factors, and fragmented care require urgent attention including equity-promoting policy.​​ Individual- and system-level barriers to pharmacoequity in CKM syndrome impede optimal CKM management, particularly among minoritized populations. We describe how a multifaceted, multi-level approach to CKM equity including interdisciplinary care and clinical decision support tools designed from an implementation science lens may help combat these inequities.

Keywords: Cardiovascular-kidney-metabolic syndrome; Chronic kidney disease; Diabetes; Health disparities; Hypertension; Pharmacoequity.