Barriers to managing heart failure in primary care

Abstract

Challenge to racism must continueEditor-As McKenzie highlights in his editorial, the emphasis to date has been on the role of racism in recruitment and career development. 1 This must continue despite initiatives and legislation such as the recent Race Relations Amendment Act, as racism still exists in the NHS. 2 We need to continue to challenge racism not only from our colleagues but also from our patients-zero tolerance is needed. 3 The importance of racism on health and health care will not diminish owing to increasing migration to the United Kingdom particularly from east European countries. The often hostile reception of the public, media, and some politicians reinforces the negative attitudes that prevail, 4 and these may manifest through acute and chronic stress to the detriment of the individual. Research on evaluating the mechanism for racism and health outcomes is in early infancy; most studies are being conducted in the United States. We agree with McKenzie that further funding is needed in this area.The biological models alluded to seem plausible, but before investigating these further substantial research needs to be done first to define, measure, and validate "racism" as an epidemiological variable. Then we need studies to disentangle the effect of racism on health. Urgency and opportunity exist to initiate a national ethnic cohort study within the planned UK Biobank study (www.ukbiobank.ac.uk) to include examination of the effect of racism on health outcomes.

Impact of specialist care in patients with newly diagnosed heart failure: A randomised controlled study

“…Specialist care in the community supported by heart failure nurses provides a useful bridge between primary and secondary care, allowing continued clinical assessment and appropriate titration of drug treatment as well as continued patient education [34].…”