{"id":4187,"date":"2023-02-23T15:14:01","date_gmt":"2023-02-23T15:14:01","guid":{"rendered":"https:\/\/integratedcarejournal.com\/?p=4187"},"modified":"2023-03-29T10:01:34","modified_gmt":"2023-03-29T10:01:34","slug":"the-nhs-must-break-the-cycle-on-heart-failure","status":"publish","type":"post","link":"https:\/\/integratedcarejournal.com\/the-nhs-must-break-the-cycle-on-heart-failure\/","title":{"rendered":"The NHS must break the cycle on heart failure"},"content":{"rendered":"

In the midst of its most challenging period of pressure, diagnostics have a significant role to play in helping to alleviate patient backlogs and free up vital resources across the sector \u2013 and nowhere is this more critical than with heart failure.<\/p>\n

The health challenge that heart failure, a serious and chronic disease that prevents the heart from pumping blood through the body, poses to the NHS is both immense and relentless.\u00a0 An estimated one million people live with heart failure in the UK, with approximately 200,000 developing the condition every year, creating a profound and multifaceted set of health challenges for the NHS.<\/p>\n

Writing in a recently published report<\/a> by PPP for Roche Diagnostics UK & Ireland, Professor Sir Mike Richards described diagnostics as a \u201cCinderella\u201d service within the NHS. Yet the UK\u2019s capacity to diagnose heart failure has been consistently hampered by broader capacity challenges in NHS diagnostic service provision, as well as the lack of uptake of, and access to, innovation. A combination of workforce shortages and outdated facilities have historically contributed to late diagnosis and poorer health outcomes. This realisation directly informed Professor Richard\u2019s 2019 report, which led to the introduction of community diagnostic centres (CDCs).<\/p>\n

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A \u2018silent epidemic\u2019<\/strong><\/h3>\n

Heart failure is notoriously difficult to diagnose, in part because its key symptoms \u2013 breathlessness, exhaustion and ankle swelling \u2013 can be caused by a number of other conditions. As a result, late diagnosis of heart failure is unfortunately common, often only occurring once a patient has presented in secondary care following the onset of severe symptoms.<\/p>\n

“If heart failure patients are picked up early in the community in primary care, the evidence shows that management of the disease is much better”<\/p><\/blockquote>\n

\u201cCurrent estimates are that 80 per cent of patients are diagnosed [with heart failure] after a hospital admission,\u201d explains Dr Harper, \u201cand a significant proportion of those will be emergency cases, and so these patients are at the late stage, requiring more intense and complex treatment.\u201d This matters because heart failure patients who require hospitalisation account for \u201csomewhere in the region of a million inpatient days every year, which is about 2 per cent of total NHS annual bed days\u201d. It is also estimated that between 2-4 per cent of the total annual NHS budget is spent managing patients with heart failure (up to \u00a36 billion in 2022\/23) and according to Dr Harper, \u201cthe majority of this burden is due to hospitalisation \u2013 and hospital admissions for heart failure have increased by 50 per cent in the last decade alone\u201d.<\/p>\n

\u201cSomewhere in the region of 70 per cent of the total annual cost [of managing heart failure] is actually utilised by the management of stage four patients alone,\u201d says Dr Harper, \u201cbut if heart failure patients are picked up early in the community in primary care, the evidence shows that management of the disease is much better; they have a better quality of life; and significantly reduced requirements of both primary and secondary care services ongoing.\u201d<\/p>\n

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Diagnostic reform<\/strong><\/h3>\n

“The NHS must look to adopt innovative diagnostic tools at a faster rate”<\/p><\/blockquote>\n

As was made clear in Professor Richards\u2019 report, the NHS must conduct a wholesale rethink of diagnostic service provision. \u201cEarly diagnosis is key to effective management and better outcomes for these patients\u201d, explains Dr Harper, \u201cbut while the use of medicines which are deemed to be beneficial and cost effective is mandated in the UK, diagnostics aren\u2019t. It can often take 10 or more years for a diagnostic test to be widely adopted across the NHS.\u201d As such, the NHS must look to adopt innovative diagnostic tools at a faster rate.<\/p>\n

NT-proBNP tests are fast, cost-effective, non-invasive and recommended by NICE for the diagnosis of heart failure. Recently updated NICE Quality Standards, recommend that this test be conducted on all patients presenting to primary care with a possible heart failure diagnosis, but this guidance is not universally followed with recent data showing that only 18.3 per cent of heart failure patients had an NT-proBNP test recorded.<\/p>\n

\u201cFollowing the NICE guidance for NT-proBNP testing\u00a0 can reduce unnecessary referrals and allow GPs to better identify patients that do need more urgent referrals for echocardiograms\u201d, Dr Harper notes, which is important because \u201cwe\u2019ve got massive echocardiogram backlogs, with patients waiting months\u201d, many of whom may not need one at all. The ability to preclude a heart failure diagnosis early would reduce the echocardiogram bottleneck, meaning those who really need one can access one sooner. \u201cI think mandated funding for NT-proBNP would go a long way,\u201d says Dr Harper. \u201cThis approach could help to potentially flip the site of primary diagnosis from 80 per cent in hospital to 80 per cent in the community, and therefore reduce pressure on the NHS.\u201d<\/p>\n

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Reprioritising and reframing the issue of heart failure<\/strong><\/h3>\n

Dr Harper believes that \u201cthere\u2019s a strong case for heart failure to be prioritised by NHS England in the upcoming NHS Long Term plan refresh with clearly defined targets, such as exist for stroke and cardiac arrest.\u201d Accordingly, \u201cthere needs to be increased collaboration between the NHS, industry and patient organisations to tackle inequalities in the diagnosis and management of patients.\u201d<\/p>\n

Much of this comes down to a need to educate and raise awareness of heart failure and its symptoms. \u201cIt has been described as a \u2018silent epidemic\u2019 because it hasn\u2019t received as much attention as other pressing healthcare issues,\u201d Dr Harper remarks. This lack of awareness has produced some alarming disparities, particularly around gender and misdiagnosis.<\/p>\n

“Clinicians seeing female patients with the symptom of breathlessness should have heart failure at the top of their differential diagnostic list\u201d<\/p><\/blockquote>\n

\u201cThere is an historical\u00a0 presumption that heart failure is a more male-dominated disease rather than female,\u201d he explains, \u201cwhen actually it\u2019s about a 50\/50 split.\u201d Despite this, women are more likely to be misdiagnosed than men or to wait for much longer than men for their diagnosis. Dr Harper continued, \u201cclinicians seeing female patients with the symptom of breathlessness should have heart failure at the top of their differential diagnostic list.\u201d<\/p>\n

Echoing recommendation three of Breaking the cycle<\/em>, Dr Harper also encourages widespread adoption of the Pumping Marvellous Foundation\u2019s BEAT symptom tracker. If shared with the wider public, this checklist \u2013 Breathlessness, Exhaustion, Ankle Swelling, Time for a simple blood test \u2013 could increase heart failure symptom awareness and ensure that more cases are identified sooner and treated more effectively.<\/p>\n

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Conclusion<\/strong><\/h3>\n

“Ensuring primary and secondary care professionals share a common goal is key”<\/p><\/blockquote>\n

A coherent and system-wide approach will be needed if capacity is to be increased across all diagnostic modalities, but especially in heart failure. \u201cEnsuring primary and secondary care professionals share a common goal is key,\u201d Dr Harper says, \u201c[and] the introduction of integrated care systems is a great opportunity to foster this collaboration.\u201d<\/p>\n

\u201cBy increasing diagnostic capacity in the community, we might be able to reduce the pressure on hospital admissions and NHS bed days,\u201d and the use of NT-proBNP tests to confirm or rule out suspected cases of heart failure will be crucial. Taking the present opportunity to radically overhaul the heart failure diagnosis pathway will help to decrease the societal burden of the disease, create extra capacity for the NHS and, most importantly, help heart failure patients lead longer, healthier lives.<\/p>\n

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Breaking the cycle: Tackling late heart failure diagnosis in the UK<\/em><\/a>, finds that late diagnosis of heart failure is a significant hindrance to the effective management of heart failure. It makes a series of recommendations to NHS England, Health Education England, and integrated care systems, as well as patient groups and industry to come together to improve heart failure diagnosis across the entire healthcare system.<\/p>\n","protected":false},"excerpt":{"rendered":"

Integrated Care Journal recently spoke to Dr Ashton Harper, Head of Medical Affairs (UK & Ireland) at Roche Diagnostics, to examine the heart failure diagnostic pathway and identify where the biggest opportunities in NHS diagnostics exist. <\/p>\n","protected":false},"author":20,"featured_media":4189,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[31,35,25,33,26],"tags":[],"acf":[],"_links":{"self":[{"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/posts\/4187"}],"collection":[{"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/users\/20"}],"replies":[{"embeddable":true,"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/comments?post=4187"}],"version-history":[{"count":10,"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/posts\/4187\/revisions"}],"predecessor-version":[{"id":4198,"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/posts\/4187\/revisions\/4198"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/media\/4189"}],"wp:attachment":[{"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/media?parent=4187"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/categories?post=4187"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/integratedcarejournal.com\/wp-json\/wp\/v2\/tags?post=4187"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}