Primary Care: A Call to Action
Dealing with the growing burden of heart failure is one of the major health challenges of this century. Around one million people are living with the condition across the UK, with a further 200,000 new diagnoses each year.
Over the last decade, advances in medical therapy and rehabilitation, alongside the development and adoption of NT-proBNP diagnostic tests, offer a critical opportunity to relieve this growing burden. Despite progress, the full potential of this revolution in heart failure care has yet to be fully realised across the NHS. This is particularly evident in primary care.
Local and national leadership must now urgently support and prioritise a change in culture across primary care to dramatically improve the early diagnosis and management of heart failure.
This report draws on over five years of learning and working with primary care heart specialists. It lays out pragmatic, evidence-based solutions to achieve this: from improving the uptake of NT-proBNP testing, expanding screening via pharmacies and Community Diagnostic Centres, to supporting primary care to better optimise medication in the community.
Our recommendations to the government:
Detection and diagnosis in primary care
- Create a culture across primary care for a proactive and accurate heart failure case finding using NT-proBNP testing
- Expand timely diagnostic capacity through pharmacies, Community Diagnostic Centres and practice nurses in GPs
- Integrate specialist heart failure care into primary care services to support faster diagnosis and treatment
Managing heart failure in the community
- Design and commission services that optimise heart failure medication management in primary care
- Embed integrated, multidisciplinary models of care focused on preventing readmissions
- Create a culture of continuous education, audit, and improvement for managing heart failure in the community
Heart Failure: A Call to Action
Where heart failure care is at its best, patient outcomes can be greatly improved, significantly prolonging life expectancy and restoring some quality of life. However, widespread regional variation means that service delivery is patchy and inconsistent. That was the conclusion of an Inquiry into heart failure services by the All Party Parliamentary Group on Heart Disease in 2016.
Today, with heart failure featuring prominently in the NHS Long Term Plan and a growing number of regional NHS plans, this report looks at the progress that has been made on the APPG’s recommendations, evaluates what further action needs to be taken and proposes ten new recommendations for improvements.
Access the ten new recommendations
Why focus on heart failure?
Heart failure was a key priority before Covid-19. The condition affects over 900,000 people in the UK, with 200,000 more cases diagnosed every year.
If action was urgently needed before the pandemic, it should be an even greater priority now.
- Over 900,000 people affected, with 200,000 more cases diagnosed every year.
- Accounts for approximately 2% of the annual NHS budget, and 5% of all emergency admissions
- Hospital admissions for heart failure are set to rise by 50% in the next 25 years.
- The mortality of patients hospitalised with heart failure remains high overall at 10.1%.
- During Spring 2020, daily hospitalisations for heart failure in England decreased by 54%[i], with heart failure and myocardial damage being associated with the long-term effects of Covid-19.
Key recommendations from the report
Here is a summary of three of the recommendations for improving heart failure care: early diagnosis, specialist multidisciplinary support, and cardiac rehabilitation.
Early diagnosis
NT-proBNP:
- The Alliance for Heart Failure recommends that all Clinical Commissioning Groups (CCGs) should commission NT-proBNP testing to eradicate any residual regional variation in access. Health Education England should support initiatives to encourage its use for diagnostic purposes by GPs, community diagnostic hubs, and emergency departments. NHS England should support pathway adherence by providing access to the Pathway Transformation Fund.
Echocardiography:
- The echocardiography workforce shortage should remain an urgent priority for Health Education England. CCGs and Trusts should ensure that the correct diagnostic tools, such as the use of NT-proBNP testing to rule out heart failure, are used to alleviate pressure on echocardiography services.
Specialist multidisciplinary support
Input and review:
- NHS England and NHS Improvement should improve the inter-hospital variation of specialist input and review, ensuring specialist care or outreach to non-specialist teams, is available everywhere. Acute Trusts should include the percentage of heart failure patients seen by the specialist multidisciplinary team on their Annual Safety and Quality Report.
Follow-up:
- All CCGs should commission heart failure services centred on MDTs, ensuring they follow up patients to full capacity, following the NICE recommendation that all patients are discharged with two-week follow-up appointments.
Cardiac rehabilitation
Uptake and access:
- All CCGs should prioritise uptake and equitable access to cardiac rehabilitation. Professional bodies like the Royal College of General Practitioners (RCGP) should increase awareness of the benefits among GPs and primary care professionals to increase uptake in line with the NHS Long Term Plan.
Access the ten new recommendations
“Heart failure patients deserve better, no matter where they live. Access to early diagnosis, specialist multidisciplinary support, high-quality information, cardiac rehabilitation and end-of-life care makes a real difference and should be universal.”
Louise Clayton & Richard Corder
Co-Chairs, Alliance for Heart Failure
[i] Wu, J., 2021. Second Decline in Admissions With Heart Failure and Myocardial Infarction During the Covid-19 Pandemic. Journal of the American College of Cardiology, [online] Available at: <https://www.jacc.org/doi/10.1016/j.jacc.2020.12.039> [Accessed 10 February 2021].