Improving care for patients in Wales living with heart failure should be a priority according to a new report from the British Heart Foundation (BHF). Disjointed and unequal care, exacerbated by the Covid-19 pandemic, is leading to more people dying with heart failure.

The report 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. The Covid-19 pandemic has likely intensified these problems, but there is limited information about how many patients have accessed care and support, if at all, during this period (2).

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, 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.

Joanne Oliver, BHF Cymru Health Service Engagement Lead, said: “Heart failure is a devastating, incurable illness and the need to support patients is absolutely vital. The Covid-19 pandemic and its impact on health services has brought this into even sharper focus. We are working closely with Wales Heart Conditions Implementation Group, Wales Heart Failure Forum and the All Wales Heart Failure Specialist Nurse Forum, so that all patients can have access to the best care.

“BHF Cymru wants outcomes improved for patients with heart conditions living in Wales. We are developing recommendations in partnership with patients and clinicians across Wales, and improving care for people living with heart failure is one of the priorities that we want the Welsh Government to take forward over the next five years.”

According to the BHF, more than 34,000 people in Wales have been diagnosed with heart failure by their GP (3), and estimates which include diagnoses at hospital, suggests there are likely to be thousands more people living with the condition across the country.

Heart failure is an incurable condition which means the heart doesn’t pump blood around the body as effectively as it should. It affects nearly one million people in the UK and can be diagnosed through a simple blood test and echocardiogram – both of which could be done in GP surgeries, or elsewhere in the community.

Nearly half of people (48 per cent) diagnosed with heart failure in the UK die within five years of their diagnosis (4), but the mortality rate can vary according to geography, ethnicity and socioeconomic background,

Swansea Bay Community Heart Failure Service has adapted the delivery of its heart failure service in response to the Covid pandemic. Routine hospital and community heart failure clinics were stopped and a temporary service was aimed at patients at the greatest risk of hospital admission.

Dr Carey Edwards Consultant Cardiologist at Swansea Bay UHB explains:

“We tried to develop a structured approach to screening and review, but heart failure patients’ needs are often complex and challenging, and we acknowledged that there needed to be flexibility in our system to account for this. The service has been well received by primary care and patients and we are now working on a plan for returning to our normal clinics while maintaining what has been working well for patients in their community.”

Swansea Bay Community Heart Failure Service established a community-based heart failure hub separate to acute hospital sites. They aimed to keep the clinic COVID-19 free by screening patients for symptoms of infection prior to review. The Hub’s services include:

A rapid access diagnostic clinic, where patients are seen promptly with ECG, echo and consultant review.
Patients with confirmed heart failure are supported by the community heart failure nursing team.
There is also support for known heart failure patients. Including screening, telephone reviews and remote contact with the community heart failure team wherever possible.
Face-to-face reviews are available for those patients who need support from a heart failure specialist nurse.

Adam Fletcher Head of British Heart Foundation Cymru, said: “There is no cure for heart failure, but decades of research have given us treatments that allow people to live well with this condition for many years with the right care and support.

“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.”