Louise Clayton
Co-Chair, Alliance for Heart Failure, Advanced Nurse Practitioner, and Deputy Chair of the British Society of Heart Failure Nurses Forum
Heart failure is a key health concern of our time. The COVID-19 pandemic has only brought that into clearer focus. Now, much more needs to be done to improve care.
Early diagnosis is a key factor in ensuring heart failure patients receive the right treatment and care. Only around one in 14, however, receive their diagnosis via their GP.1 What’s more, around 23,000 new cases are thought to have been missed because of the pandemic.2
The problem is that heart failure can be difficult to diagnose. Its signs and symptoms, including breathing difficulties and swollen lower limbs, can also be caused by other common conditions. It means patients are often mis-diagnosed with chest infections, asthma, and stress.
Initiatives are underway to improve GP education and public awareness, but more could be done. Appointing a heart failure champion in every Primary Care Network, for example, would ensure a higher profile for the condition and better patient outcomes.
Specialist care is key
Good specialist care, including heart failure nurses at an early stage, can make a real difference to patient care and can reduce hospital readmissions.3
The number of patients seen by specialists is thankfully improving, up from 80% five years ago to 82% in 2018.4 The proportion seen by specialists on general wards has changed little though and variation between hospitals is still a major issue. Ironing this out is essential in improving patient outcomes.
The problem is that heart failure can be difficult to diagnose. Its signs and symptoms, including breathing difficulties and swollen lower limbs, can also be caused by other common conditions.
Involving and empowering patients
The NHS Long Term Plan highlighted the role of exercise-based programmes in reducing the risk of people dying prematurely from cardiovascular disease.5 As well as exercise, these also include lifestyle advice, dietary guidance, smoking cessation support and education which are proven to reduce mortality. Even a modest increase in uptake can result in a marked improvement in patient outcomes.6
NHS England has set an ambitious uptake target of three in 10 patients, from just under ten% currently. COVID-19 has hampered this, however, with group exercise take-up falling by over a third.7 A greater shift towards home-based, digital programmes is surely part of the answer.
A service that patients deserve
The challenges heart failure care faces have only intensified over the past twelve months. Addressing these issues is paramount for the NHS recovery and to avoid longer-term repercussions of underdiagnosis.
Above all though, it will deliver a heart failure service that patients deserve.
More detail can be found in the Alliance for Heart Failure ‘Heart Failure: A call to action’ report, published in February 2021, which outlines ten recommendations for improving heart failure care.
References
[1] Censuswide data from a survey of 625 heart failure patients in 2020 as part of the Heart Failure: The hidden costs of late diagnosis. Roche Diagnostics Limited, Pumping Marvellous 2020, along with HES data covering all hospital activity relating to seven heart failure ICD-10 codes, captured as a primary diagnosis between April 2018 and March 2019. Available at: https://rochereport.readz.com/the-heart-failure-challenge
[2] Without skipping a beat, Institute for Public Policy Research (IPPR), 2021. Without skipping a beat | IPPR
[3] The development and impact of the BHF and Big Lottery Fund heart failure specialist nurse services in England: Final report, University of York, April 2008. Available at: G234 Heart failure nurse services in England report 2008 | BHF
[4] National Heart Failure Audit, NICOR 2016-17 and 2019
[5] NHS Long Term Plan.
[6] NICE: Chronic heart failure in adults: diagnosis and management (NG106, September 2018): https://www.nice.org.uk/guidance/ng106
[7] Without skipping a beat, Institute for Public Policy Research (IPPR), 2021. https://www.ippr.org/research/publications/without-skipping-a-beat
