UK survival rates lag behind the rest of Europe

Treatment of heart failure, which is placing the NHS under severe strain, can be a postcode lottery, as Liz Bestic reports

It affects around one person in a 100 and the number of people suffering heart failure in the UK is set to rise significantly over the next 20 years. This is due to the combined effects of an increased survival rate among patients with cardiovascular disease and an ageing population.

Heart failure occurs when the heart no longer pumps blood around the body effectively. The most common reason for the condition is when the heart muscle has been damaged by a heart attack, but it can also be a complication of some heart operations.

There is limited evidence to prove that lifestyle changes make a big difference to the risk of heart failure, but high blood pressure and smoking are risks for heart health, and tackling these could help reduce symptoms and improve quality of life.

In population-wide studies, survival rates for heart failure are worse than for breast and prostate cancer. Between 10 and 50 people with heart failure die from it every year, depending on the severity, the cause and how well it has been treated.

Providing services to patients with this condition costs the NHS an estimated £625 million each year. Heart failure is in the top ten reasons for hospital stays, placing significant demands on hospital facilities and resources through emergency admissions and readmissions.

If life-enhancing drugs were prescribed prior to hospital discharge, we would save thousands of lives every year

Yet, with earlier diagnosis and proper treatment, experts believe many hospital visits could be prevented. “There is good evidence to show that appropriate diagnosis, treatment and management can not only help reduce admissions to hospital, but also improve survival and quality of life”, says Dr Suzanna Hardman, consultant cardiologist at Whittington Health, in north London, and chairwoman of the British Society for Heart Failure.

“The truth is there are still far too many cases of heart failure being diagnosed in hospitals, at an advanced stage, after missed opportunities to pick the condition up earlier. This failure is then too often compounded by inadequate hospital care with increasing pressures for early discharge, rather than high-quality care. The NHS needs to focus more energy on what happens in hospital and ensure this resource is used to optimise patient outcomes.”

There is also evidence that GPs may find it difficult to identify heart failure early. “Diagnosis of heart failure is complicated, and we are currently working to raise awareness of the condition and the importance of early assessment and referral,” says Dr Hardman.

A positive diagnosis must also ensure appropriate treatment, much of which is delivered within the community through a heart failure team. But, according to some experts, such services remain patchy.

The National Heart Failure Audit, a state of the nation report on services for people with heart failure produced in partnership with the British Society for Heart Failure, shows that, while progress has been made over the last two years, there is still significant variation in heart failure care across the country.

“We still hear of patients who are not getting life-enhancing drugs,” says Dr Hardman. “The audit suggests that, if these drugs were prescribed prior to hospital discharge, we would save thousands of lives every year. The quality of care during an admission determines survival in hospital, but also wellbeing and mortality over the subsequent twelve months and beyond.”

A recent British Cardiovascular Society report highlighted the importance of managing heart failure in specialist cardiac care units.

Dr Hardman concludes: “All the evidence suggests that patients who see a cardiologist on admission to hospital, are given specialist multidisciplinary care in a dedicated unit, have a heart scan and go home on key relevant drugs in adequate doses, with early follow-up involving their GP and specialist nurses, have far better outcomes.”