Disjointed heart failure care is needlessly costing lives, new BHF report warns
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Disjointed and unequal care, likely exacerbated by the Covid-19
pandemic, is leading to more people dying with heart failure,
according to a new report from the British Heart Foundation (BHF).
The report, Heart Failure: A Blueprint for Change, reveals that
prior to lockdown, UK hospital admissions for heart failure had
risen by nearly a third (29 per cent) over the last five years to
more than 100,000 per year (1). This could be in part due to missed
opportunities to diagnose...Request free
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Disjointed and unequal care, likely exacerbated by the Covid-19
pandemic, is leading to more people dying with heart failure,
according to a new report from the British Heart Foundation (BHF).
The report, Heart Failure: A Blueprint for Change, reveals that prior to lockdown, UK hospital admissions for heart failure had risen by nearly a third (29 per cent) over the last five years to more than 100,000 per year (1). 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 (2). 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. 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 (3). However, there is limited information about how many patients have accessed care and support, if at all, during this period (4). The BHF is 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 charity says that 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 (48 per cent) diagnosed with heart failure die within five years of their diagnosis (5), but the mortality rate can vary according to geography, ethnicity and socioeconomic background, suggesting there are missed opportunities for improvement. To address the heart failure care crisis, the BHF has laid out a “blueprint for change,” which it says would improve care standards and alleviate pressure on the health service if implemented. Professor Sir Nilesh Samani, Medical Director at the British Heart Foundation, 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 BHF says it is crucial that there are significant changes to the way heart failure services are delivered across the UK. It has laid out a series of recommendations, which 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.
Dr Simon Williams, Consultant Cardiologist at Wythenshawe Hospital and Chair of the British Society for Heart Failure said: “Heart failure rarely exists in isolation, so improving outcomes for people with this condition as a blueprint for management of other long term conditions is crucial. “Whilst it remains a burdensome, debilitating and potentially life threatening condition, it is possible to live well with heart failure. This is an important aim of the care we provide as heart failure specialists.” Nick Hartshorne-Evans, CEO and Founder of the Pumping Marvellous Foundation, said: “Having been diagnosed and treated for heart failure, I have first-hand knowledge of the importance of a swift diagnosis and having access to a team of capable healthcare specialists. “This report highlights how Covid-19 has amplified a previously fragmented system, underinvested and under-resourced, to meet the needs of people living with heart failure. During the pandemic, heart failure services had the “rug pulled” from under its feet, and this had a direct impact on people living with the condition. “Patients need to see but also feel a re-assembling of pre-Covid-19 heart failure services and also a more effective method of dealing with the pandemic of heart failure in the future. We know what good looks like; we need to do it.” Dr Jim Moore, President of the Primary Care Cardiovascular Society, said: “Heart Failure: A Blueprint for Change clearly outlines the challenges we face in providing high quality care across all aspects of service delivery for the most vulnerable group of patients we see with cardiovascular disease while providing clear guidance as to how they should be addressed. “There is little doubt that COVID has significantly increased these challenges bringing an urgent need for a national focus on the healthcare provision for heart failure patients - something which is long overdue.” Professor Simon Ray, President of the British Cardiovascular Society, said: “Effective treatment of patients with heart failure is one the major challenges that cardiology teams face in day to day practice. This has been even more the case during the COVID pandemic when care has been severely fragmented. “As this report makes clear there is a pressing need to make heart failure care both more readily accessible to patients and more joined up across community, primary and specialist care.” CASE STUDY 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?” ENDS References
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