Knowledge that the risk of dying prematurely from coronary heart disease is 50 per cent higher in the South Asian community - immigrants from India, Pakistan, Bangladesh and Sri Lanka - than in the indigenous population has been available for more than half a century.
A contributing factor to this significant health inequality is the underuse of cardiac rehabilitation services, identified in a 1997 piece of government research as resulting from cultural and linguistic barriers. The national service framework for coronary heart disease of 2000 recommended the inclusion of culturally relevant measures to increase the appeal of cardiac rehabilitation programmes.
Research examining how these services might be better attuned though is scarce and offers little as a guide to day-to-day practice. A partnership between Whipps Cross University Hospital trust, Waltham Forest race equality council, Waltham Forest primary care trust and several South Asian community organisations set out to develop a programme that addresses this issue in a London borough where South Asians account for 15-20 per cent of the local population and a third of admissions to coronary care.
Preliminary data from an early pilot study presented to the British Cardiac Society in 2004 showed significant outcomes in uptake, compliance, quality of life and reduction in modifiable risk factors. This work was moved on to an advanced second stage - Coronary Artery Disease in South Asian Prevention Project (CADISAP) - as Dr Sandy Gupta, consultant cardiologist at Whipps Cross and lead investigator on the project, explains. 'What we have been doing, and this is a first in terms of a randomised control trial, is to compare a culturally sensitive versus a conventional cardiac rehabilitation service in a South Asian population.'
The multidisciplinary four-phase service is delivered from both hospital and community venues, uses bi-lingual dieticians and translators and provides education, dietary and weight management advice, healthy food preparation classes, supervised exercise, relaxation therapy and smoking cessation counselling.
'We had no idea before but we are learning,' continues Dr Gupta, 'that South Asians need to have a focused strategy ? get that right and you can improve the uptake, the adherence and compliance. Hopefully we can also go on to show a reduction in risks factors, more understanding of medication and an improvement in quality of life indicators.'
'South Asians emigrate everywhere,' says Dr Gupta, 'whether it's South Africa, Trinidad or Singapore. The findings of this culturally sensitive study have potential application across the globe.'