Other Issues

Ethnicity

It is well recognised that certain ethnic groups, for example South Asians, experience significantly higher rates of heart disease than the rest of the population. Research has shown, however, that minority groups often encounter inequity of access to a range of services. Unfortunately, this issue could not be explored as ethnicity was very poorly recorded in all the data sources used. Although Wirral has a relatively low proportion of residents from ethnic minority groups, these individuals will have specific needs, which may be unrecognised. It is important, therefore, that the information collected with regard to ethnicity is improved and that the specific CHD needs of ethnic groups are considered by all health professionals.

Data availability and quality

Primary care clearly plays a crucial role in the prevention and treatment of heart disease. Information from primary care would help quantify the burden of disease associated with CHD, the level of need for services and the degree of inequity. Useful data could include numbers of patients with angina or high blood pressure; details of referrals to hospital for special investigations such as angiography; and details on the use particular medications. Although such information is not yet readily available, the establishment of a CHD register, in line with the recommendation in the NSF and which is currently underway in every Wirral practice, will be very useful.

All local services provided to support the prevention and treatment of CHD should set up and maintain databases to inform future equity profiles. This would include the new Fitness and Lifestyle Centres; Wirral Heart Support Centre; and the Rapid Access Chest Pain Clinic. Access to investigations such as echocardiography and exercise tests should also be monitored to ensure equity.

Targeting resources and initiatives

Whenever new initiatives and services are introduced, deprived populations and areas, which bear the brunt of the effects of heart disease should be specifically targeted. In particular, the development of programmes aimed at modifying lifestyle factors should be encouraged. In addition, ensuring equity of access should be a specific objective for all our services, which needs to be evaluated regularly.

Use of agreed protocols and guidelines

Some of the observed disparities in access to CHD services outlined above may stem from variations in the management of those with heart disease by health professionals. One way of reducing these is the development and use of agreed protocols and guidelines. These could cover referrals for a consultant cardiology opinion; angiography; revascularisation; or cardiac rehabilitation. This approach is recommended in the NSF and guidelines for the management of heart failure were successfully produced and launched for use across Wirral in December 2000.