Ethnicity, heart failure and the prevention continuum: time to act

Every UK Census since 1841 has collected data regarding country of birth and nationality. However, ethnicity was recorded from only the 1991 census onwards. The number of categories and their complexity has increased over the years. Race and ethnicity are overlapping concepts, but ‘the term race should be used with caution for its history is one of misuse and injustice’.1 Race refers to a person’s skin colour and origins, whether by nationality or country of birth. Ethnicity tends to refer more subjectively to a shared history and culture, language, religion and traditions. South Asians are the largest ethnic minority group in the UK (4.9% in the UK 2011 Census) and provide an important lens for research and action to address ethnic disparities in health and healthcare. Since the 1980s, inequalities in diagnosis, treatment and monitoring of coronary artery disease (CAD) in ethnic minority communities, particularly South Asians, have been reported. The demonstration that South Asians had higher incidence of CAD (hazard ratio, (HR) 1.35, 95% CI 1.30 to 1.40) but better prognosis (HR 0.78, 95% CI 0.74 to 0.82) compared with Caucasians suggested that ‘public health initiatives to reduce inequalities in mortality between South Asian and white populations should focus on primary prevention’.2 Further analyses implicate a combination of underlying biological factors as causes (eg, adipose tissue distribution and metabolism), as well as environmental, demographic, social and behavioural factors. Although similar research may guide aetiological, preventive and therapeutic insights in both individuals and populations, other CVDs and non-communicable diseases have not been so well studied. Research and management of heart failure (HF), a major global burden of disease with variations in diagnosis and treatment within and across countries, can benefit from analyses by ethnicity. ICD therapy is a major component of treatment of both ischaemic and …