The UK is not consistently meeting recommended standards in heart failure care, according to a new survey presented at the British Cardiovascular Society Conference in Manchester today.
The survey, which was led by Helena Masters, a Heart Failure Nurse Manager at Novartis, showed a worryingly wide variation in the care someone with heart failure can expect depending on where they live in the UK. (1)
This is despite updated NICE guidelines for chronic heart failure, which provide recommendations on best practice for the diagnosis and management of the condition. (2)
The guideline, published in September 2018, set provisions for diagnosing and managing chronic heart failure in people aged 18 and over. They are designed to improve diagnosis and treatment of heart failure, and to extend the length and quality of life for people with the condition.
Heart failure is when the heart is not pumping blood around the body as well as it should be. This commonly occurs when the heart muscle has been damaged, such as following a heart attack. People with heart failure can find everyday tasks like dressing themselves or climbing the stairs exhausting and it is important that they receive a high level of care to manage their condition.
According to the survey, each service covered a population of around 600,000 people (3), containing on average around 1,600 people with heart failure. (4)
Although the survey has anonymised the best and worst performing locations, differences across the country are stark (5). For example, in a quarter of the services, people with heart failure are cared for by just one or two nurses. Meanwhile, those that are the best-served have more than seven nurses.
The findings also show that almost one quarter (24%) of surveyed services have no administrative support. This means that already over-worked doctors and nurses have to spend extra time dealing with paperwork instead of supporting patients.
Meanwhile, around one in seven of the services did not have a consultant or a lead physician with a specialty in heart failure, highlighting another deficit between NICE guideline recommendations and clinical practice.
The impacts of living with heart failure aren't just physical. Past studies have shown that there is a link between living with heart disease and mental wellbeing. A previous British Heart Foundation (BHF) survey of more than 2,700 people with heart conditions found that 68% were also being affected by their condition mentally, emotionally or psychologically.
Of those people, 77% said that they had anxiety caused by their condition. Despite this, 67% of people said that they did not speak to anyone about the emotional or psychological impact it created. This is made even more concerning by the fact that the survey led by Helena Masters showed that only 15% of heart failure services have a mental health professional working within their team.
Helena Masters, Nurse Manager at Novartis, who lead the survey, said:
"These findings show that there is a worrying lack of consistency in heart failure services provided across the UK.
"Around one in seven of the services surveyed don't have either a consultant or a lead physician who specialises in heart failure, highlighting a concerning deficit between NICE guideline recommendations and clinical practice.
"With ever increasing numbers of heart failure patients, it is important that each area of the country has the resources to improve and extend the quality of life of people living with this debilitating condition. There are innovative and effective treatments for heart failure, so it's vital that patients are diagnosed early and have access to specialist care."
Professor Metin Avkiran, Associate Medical Director at the BHF, said:
"There are more than 900,000 people living with heart failure in the UK. This is a long-term condition that often gets worse over time. As well as the day-to-day challenges, people with heart failure are more likely to suffer a stroke and late-stage heart failure has very poor survival.
"As more and more people can expect to survive a heart attack, there are a growing number of people at risk of developing heart failure later in life. We need to have the right services in place to physically and mentally support them.
"The BHF is committed to ensuring that everyone living with heart failure receives the right support, no matter where they live. We are currently funding around £49 million of research into heart failure, to improve the outlook for people with this devastating condition.
"While research will provide new solutions in the future, services across the UK need to make sure they're providing appropriate care as guided by current evidence."
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To request interviews or for more information please call the BHF press office on 020 7554 0164 (07764 290 381 - out of hours) or email newsdesk@bhf.org.uk. There are no full papers but scientists' abstracts are available
Notes to editors:
100 heart failure services completed the survey. 56 heart failure nurses and 44 heart failure cardiologists provided data for 67 trusts and one social enterprise in England, and five health boards in Scotland, four in Wales and two in Northern Ireland.
NICE Chronic heart failure in adults: diagnosis and management https://www.nice.org.uk/guidance/ng106/resources/chronic-heart-failure-in-adults-diagnosis-and-management-pdf-66141541311685
Ranging between 22,000 to 3.5 million population size served by heart failure services
Ranging between 60 to 20,000 heart failure patients under the care of these services
26% of surveyed services have 1-2 nurses, while 22% have 3-4 nurses. 24% of services have 5-6 nurses and 28% have more than 7.