Detecting heart failure early saves lives
Cardiology Almost one million people in the UK have heart failure. Yet lack of recognition, compounded by inequitable access to crucial tests, means that many patients suffer because of late diagnosis.
Early diagnosis could save lives – but huge numbers of people living with the condition are undiagnosed, and untreated.
This results in poor quality of life, frequent and prolonged hospitalisation and early risk of death.
Dr Paul Kalra, Chairman of the British Society for Heart Failure (BSH), said the condition’s “major and increasing burden on the NHS could be lessened if patients were diagnosed and treated earlier”.
“Quite simply, if people with suspected heart failure are identified, referred to specialist services and put on the right treatment, they live longer and better,” said Dr Kalra, Consultant Cardiologist at Portsmouth NHS Trust.
Heart failure cases are increasing
He added that, between 2002 and 2014, the total number of cases had increased by almost a quarter (23%). In England and Wales alone, there are over 80,000 emergency hospital admissions a year that are primarily related to heart failure.
If anyone (not known to have heart failure) presents swollen ankles, shortness of breath or fatigue, heart failure needs to be at the forefront of your mind.
A staggering 9% (almost 1 in 10) of those die from the condition during the hospital admission.
Securing routine access to a simple blood test, which has been recommended by the National Institute for Clinical Excellence (NICE) initially in 2010 and then again this month, can tell GPs if someone needs to be referred to specialist heart failure services. A negative test means they don’t have heart failure.
Once there, they can be formally diagnosed, treatment initiated and placed under the care of a multi-disciplinary team of specialist doctors, nurses and other experts.
Where you live may restrict access to tests
The commissioners who decide which tests and services are provided in each area do not always prioritise heart failure, due to a lack of appreciation around the burden and importance of heart failure, amongst other priorities. This means the NT-proBNP and B-type natriuretic peptide (BNP) blood tests, are not available in many parts of the country.
Dr Kalra has called on the healthcare community and patient groups to unite to demand fair, equal and early diagnosis.
“The number of new cases per year has increased to 190,000. That’s similar to the four most common forms of cancer put together. If we had friends or relatives with cancer, we would want them to be seen urgently by cancer specialists,” he said.
“We would want to make sure the diagnosis was 100% accurate and that all the treatment options were explained and understood. Heart failure needs to be given the same priority.”
Heart failure is not ‘just part of getting older’
Part of the problem is a lack of awareness and understanding among the public and healthcare professionals alike, he said.
“Because the average age to develop heart failure is late 70s, many people accept or explain the symptoms as part of getting older,” he noted.
“Older people are more likely to be living with other health conditions, such as COPD, high blood pressure or type 2 diabetes. Symptoms of heart failure, which include shortness of breath and fatigue, are often attributed to these conditions.”
The BSH is working with other professional and patient organisations to drive awareness of the condition as well as the clinical and cost-effectiveness of the blood (BNP/NTproBNP) tests.
Treating the condition early, can save NHS time and money
“The average length of hospital stay for patients with heart failure is around 10 days. That’s a huge cost for the health service as well as on a personal level to the individual patient and their families,” he said, adding that tests and treatments were relatively cheap in comparison.
“We all need to be sending that message to the commissioners who set the healthcare priorities in their area.”
In the meantime, Kalra has a simple message: “Think heart failure and help improve lives. If anyone who is not known to have heart failure presents with swollen ankles, shortness of breath or fatigue, heart failure needs to be at the forefront of your mind, whether you are a patient or healthcare provider”.
Access to specialist services saves lives.
Conrad, N., Judge, A., Tran, J., Mohseni, H., Hedgecott, D., Crespillo, A.P., Allison, M., Hemingway, H., Cleland, J.G., McMurray, J.J. and Rahimi, K., 2018. Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. The Lancet, 391(10120), pp.572-580. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32520-5/fulltext
National Heart Failure Audit