The 2025 NICOR Heart Failure Audit has been published, providing insight into the state of heart failure care across the UK. While the report contains signs of progress, particularly around the increase in NT-BNP measurement, the findings highlight persistent challenges that relay the need for urgent action on the growing burden of heart failure.

Admissions & Diagnosis:

The 7% rise from 2022/23 suggests confirmed heart failure admissions are rising back towards pre-pandemic levels, in line with projections that show that cases are set to double by 2040. 

Worryingly, echocardiography rates remain below the audit target of 90%, with nearly half of hospitals failing to meet this standard. This diagnostic delay could significantly impact timely treatment initiation. However, the 10% increase in NT-BNP measurement is a positive step toward improving early detection and risk stratification.

Treatment & Specialist Care:

It is deeply concerning that only 39% of heart failure patients were treated in a cardiology ward – far below the 60% target. Specialist input is crucial for optimal care, yet only 81% of patients received specialist heart failure team input, failing to meet the 90% target.

Furthermore, only 52% of inpatients were seen by a specialist heart failure nurse, and a mere 20% of cardiology ward patients were referred to cardiac rehabilitation. These figures highlight the need for enhanced specialist workforce provision and structured rehabilitation programs.

Medication:

Pharmacological treatment remains suboptimal and variable. Alarmingly, most hospitals report that fewer than 50% of patients receive all three guideline-recommended heart failure medications. This gap in prescribing must be urgently addressed to improve long-term outcomes for heart failure patients.

Call to Action:

These results reinforce the need for a strategy in the upcoming NHS 10 year plan to deal with the growing burden of heart failure – with a focus on early diagnosis, timely treatment, and a long-term community focused plan built around rehabilitation and specialist care.

  • Increased access to echocardiography and NT-BNP testing to improve early diagnosis.
  • Adoption of BSE workforce proposals to increase access to echocardiography
  • Strengthened specialist heart failure services, including greater availability of cardiology ward beds and specialist heart failure teams (as recommended by the Alliance for Heart Failure Call to Action)
  • Improved medication optimisation through targeted initiatives such as the rapid titration service recently trialled at Barts Health NHS Trust.
  • Improved access to cardiac rehabilitation to support long-term patient recovery and prevent re-admissions.

Heart failure care must be recognised as a national priority. The Alliance for Heart Failure remains committed to working with stakeholders and to supporting multidisciplinary teams to address these gaps and drive meaningful improvements in patient outcomes.