15
Figure 6. Social Determinants of Health and Cardiovascular
Care for Patients With CCD
Actionable Steps for Clinicians and Care Teams
Economic Stability
• Low/limited income, debt
constraints
• Quality food insecurity
9Refer to social services
for local employment/
financial services options
9Provide community-
based resources and
subsidies for affordable
food options to support
healthy diet
Social Support
• Social isolation, limited social integration
9Screen for mental health/well-being, stressors
9Refer as needed to mental health
professionals
9Assess social capital/network to
support health behaviors and health care
participation
Culture and Language
• Cultural and linguistic
factors
9Ensure access to
interpreter services
9Review sociocultural
considerations affecting
health (eg, faith/spirituality,
body image, age)
9Ensure health care
workforce diversity
Systemic Racism
• Implicit and explicit bias
• Discrimination
• Constrained access to health, financial, and
physical environmental resources
9Apply equity-focused lens to care to foster
enhanced patient-provider communication
Gender Considerations and/
or Sexual Orientation
• Sex and gender bias
• Discrimination and
victimization
9Tailor care to meet patient
personal preferences
9Consider sex differences
in treatment responses
Physical Environment
• Housing instability
• Limited access to green space
• Environmental exposures
• Neighborhood crime/violence
• Rurality/dense urban areas
• Limited transportation
9Refer to social services for
viable housing options
9Provide community-based
resources for affordable and
safe recreational facilities
and municipal parks to
promote physical activity
9Provide telehealth and digital
health options (mobile
devices) to support healthy
lifestyle
Education/Health Literacy
• Low literacy
• Lack of higher education
9Assess health literacy
to ensure patient
understanding of treatment
recommendations
9Provide patient education
materials at appropriate
education level
Health Care System
• Lack of health insurance
and/or underinsured
• Limited provider access
• Poor quality of care
9Refer for insurance subsidies
for coverage of services
and medications to support
adherence as necessary
9Expand health care
services options (eg,
telehealth, extended hours,
patient portals) to foster
longitudinal follow-up
and cardiac rehabilitation
participation
9Apply value-based lens
to care
• Identifies SDOH issue.
9 Considerations for clinicians and care teams.
Adapted with permission from Lindley KJ, et al. J Am Coll Cardiol. 2021;78:1919-1929.
