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This week at the 23rd British Society for Heart Failure Virtual Autumn Meeting, Professor Nick Linker, the National Clinical Director for Heart Disease, confirmed the NHS’s clear focus on improving heart failure care and the need to reduce unwarranted variation set out in the Long Term Plan. He further announced that 54,000 additional people with heart failure (HF) and heart valve disease will be detected and diagnosed in the community by 2023/24.
The British Society for Heart Failure (BSH) contended that this figure will need significant inflation to cope with the backlog of patients likely to present with cardiovascular disease/heart failure because of the Covid-19 crisis. The current figures of approximately 1 million people with heart failure in the UK and the additional 200,000 newly diagnosed each year, are likely according to the BSH to escalate imminently.
Dr Simon Williams, Chair of the BSH, commented: “The pandemic has brutally exposed the inequalities in health service provision particularly for those with long term multi-morbid conditions such as heart failure. Inevitable consequences of Covid-19 infection will grow these numbers with heart damage likely leading to heart failure occurring in at least 10 per cent of those who are hospitalised with the virus.”
“In addition, there has been a 66% drop in attendance at hospital of those with heart failure afraid of contracting the virus, who will face inevitable complications, a trend we are already seeing in clinical practice. However, whilst it remains a burdensome, debilitating condition, it is possible to live well with heart failure. This is the main aim of the care provided by heart failure specialists and an important objective of the BSH Autumn Meeting.”
Improving cardiovascular outcomes
The BSH also welcomed Prof Linker’s community initiatives using heart failure as an exemplar, such as the setting up of regional diagnostic hubs, the NHS@Home support package, and e-learning modules from Health Education England.
Well received were also the goals of those initiatives: to reduce the time from presentation to diagnosis of heart failure from 12 months to 6, an annual functional capacity and medicines review/ imposed through the Quality and Outcomes Framework (QoF), and the elevation of the importance of heart failure to public consciousness comparable to many forms of cancer.
Additionally, the meeting welcomed the fact that NHS England has recognised the need for better heart failure care and heard that this is a big step on the journey to improved outcomes for patients. Heart failure is a complex long-term condition, rarely existing in isolation and is ultimately the destination of nearly all cardiovascular disease.
Also, in the inaugural ‘Journal of the American College of Cardiology-HF (JACC-HF) lecture’, Professor John McMurray, Professor of Medical Cardiology, Institute of Cardiovascular and Medical Sciences, University of Glasgow, introduced the concept of ‘Five Alive’ (not the fruit drink), but five pharmacological interventions which, evidence indicates, help keep heart failure patients alive and for some has extended life by five additional years.
Prof McMurray asserted that to optimise outcomes, the five treatments (in 4 pills), grouped under the acronyms RAASi (Renin-angiotensin-aldosterone system inhibitors), BB (beta-blockers), ARNI (combined angiotensin receptor and neprilysin inhibitors) and SGLT2 selective inhibitors should be taken together.
Prof McMurray commented that fast and comprehensive diagnosis and treatment is as essential for heart failure patients as for those with cancer, yet the urgency is not there. He concluded that the challenge in the next decade is to implement this evidence in clinical practice so that patients can benefit.