BHF comment
New report warns disjointed heart failure care is needlessly costing lives
Our report reveals that prior to lockdown, UK hospital admissions for heart failure had risen by nearly a third over the last five years to more than 100,000 per year. This could be in part due to missed opportunities to diagnose and treat people with the condition before they become more unwell and need to be admitted to hospital.
This is supported by research cited in the report that found that 80 per cent of people with heart failure are diagnosed in hospital, even though 40 per cent visited their GP in the previous five years with symptoms such as breathlessness, swollen ankles and exhaustion. Patients diagnosed in hospital have more advanced disease and therefore significantly worse outcomes. Earlier diagnosis can therefore save lives.
The condition, although complex, can be diagnosed in the majority of cases through a simple blood test and echocardiogram – both of which could be done in GP surgeries, or elsewhere in the community. The report calls for these tests to be more readily available to GPs.
'People are falling through the cracks'
The Covid-19 pandemic has likely intensified these problems. Latest data shows hospital admissions due to heart failure decreased by 66 per cent by the end of May in England compared to the previous year.However, there is limited information about how many patients have accessed care and support, if at all, during this period. We are concerned that many people with heart failure have fallen through the cracks of the NHS since lockdown began, adding to the picture of disrupted and fragmented care.
The multitude of issues in heart failure care is leading to needless and avoidable pressure on the NHS and has tragic consequences for patients. Nearly half of people diagnosed with heart failure die within five years of their diagnosis, but the mortality rate can vary according to geography, ethnicity and socioeconomic background, suggesting there are missed opportunities for improvement.
A blueprint for change
To address the heart failure care crisis, we have laid out a “blueprint for change” in our new report, which we say would improve care standards and alleviate pressure on the health service if implemented.
Professor Sir Nilesh Samani, our Medical Director, said: “There is no cure for heart failure, but decades of research have given us treatments that allow people to live longer and have a better quality of life with this condition with the right care and support. The key is earlier diagnosis and treatment.
“As our new report finds, too many people are falling through the cracks of our system – a result of stark disparities in heart failure care, likely made worse by the Covid-19 pandemic. This is making people more unwell, causing mental distress, and needlessly costing lives.
“As the NHS recovers from the first wave of coronavirus and prepares for its resurgence, it is vital that, as a priority, we not only switch heart failure services back on again but build them back better. By diagnosing people with heart failure early, getting them the specialist care they need, and joining up services to help them avoid admission to hospital, we can relieve some of the unsustainable pressure on the health service, and help more people with this serious condition live well for longer.”
The need for joined up care
It is crucial that there are significant changes to the way heart failure services are delivered across the UK. We have laid out a series of recommendations in our report, which is supported by: the British Cardiovascular Society, the British Society for Heart Failure, the Primary Care Cardiovascular Society, and Pumping Marvellous.These recommendations all share a common theme: the need for joined up heart failure services that are equipped to support patients all the way through from diagnosis to end of life care.
The recommendations include:
• Making heart failure care more cohesive and relevant for people’s needs, including more heart failure services that offer, as standard, diagnostic testing in the community, easier access to specialist care when needed, referral to cardiac rehabilitation and psychological support, and palliative care across GP surgeries, hospitals and other community settings.
• Improving awareness of heart failure as a long-term condition amongst healthcare professionals so they can better recognise, diagnose, and manage the condition.
• Using data to drive improvements in heart failure care, including an urgent need to identify the impact the Covid-19 pandemic has had on heart failure patients.
• Finding ‘heart failure champions’ amongst healthcare workers at a national and local level to drive improvements in services that support patients from diagnosis to end of life.
Maya's story
Dr Maya Campbell, 53, a psychologist from Colchester, has had heart failure for 11 years – the result of a heart attack and cardiac arrest in 2009, after which she was in a coma for two months.
She says she has first-hand experience of some of the issues with heart failure services highlighted in the BHF’s report.
Maya said: “I’ve had heart failure for 11 years, after having a heart attack and cardiac arrest aged 42.
“My care has been very fragmented. I saw a heart failure nurse for three months who was great, but since then, I’ve been managed by my GP practice and I see a different doctor each time.
“My condition is very variable. Some days I have lots of energy, but others I find it much harder to do things.
“I felt very inadequate and hopeless at the beginning, and I live with a fear that my heart will just stop again. Therapy and mindfulness meditation really helped me control my anxiety and emotions and find a new identity for myself. However, when lockdown began, I found it very stressful, especially when I had to start shielding.
“The pandemic has really impacted my ability to exercise, as the group support to help me do that has gone. I’ve also had to have telephone consultations with doctors over the phone – I know it’s worked for some people, but how can they really tell what’s wrong with me over the phone?”