Experts have warned that heart failure patients are dying or becoming seriously ill because of severe delays in NHS treatment.
It is feared that hundreds or even thousands of deaths and hospital admissions occur each year among patients who wait a year or more to see a specialist. Many of these deaths could be avoided if tests were carried out and drugs given earlier.
A new study shows that most patients who see their GP with symptoms of heart failure, such as shortness of breath, extreme fatigue and swollen ankles, wait at least a year to receive a diagnosis from a cardiologist.
Although heart failure is not curable, cardiologists can prescribe a variety of life-saving medications that prolong survival and significantly improve quality of life.
The most effective of these, known as SGLT2 inhibitors, can reduce the risk of being admitted to hospital for heart failure by more than 30 percent.
But treatment guidelines ban NHS GPs from prescribing drugs for heart failure, although they can prescribe them for other conditions such as diabetes and kidney disease.
Hundreds or even thousands of deaths and hospital admissions are occurring among patients who wait more than a year to see a specialist.
Critics say that as a result, patients end up in the hospital seriously ill or dying while waiting to see a specialist.
The researchers behind the findings, based on a study of more than 8,000 patients, called the delays “a scandal” and called for an immediate restructuring in the way suspected heart failure cases are handled.
“We regularly see patients who die while on the waiting list for a cardiologist,” said Dr. Lisa Anderson, one of the researchers and a heart failure specialist at St George’s University Hospitals NHS Foundation Trust in London.
‘Many also end up seriously ill in hospital. Of those, 40 percent die of heart failure within a year. These patients wait too long to see a specialist.’
According to the British Heart Foundation, more than one million people in the UK suffer from heart failure and 200,000 new cases are diagnosed each year. Heart failure develops when the heart becomes too weak to pump oxygen-rich blood throughout the body efficiently.
It is common in heart attack survivors, but can also be caused by high blood pressure, faulty heart valves, diabetes, and even sleep apnea.
The Health Foundation charity predicts that, with an aging population and rising levels of obesity, the numbers will double to two million by 2040.
People who go to their GP with worrying symptoms should have a blood test to measure levels of a protein called brain natriuretic peptide (BNP), which is produced in the heart and blood vessels. Levels in people with heart failure are often much higher than normal.
If levels are extremely high, GPs should quickly refer the patient to see a specialist within two weeks. A cardiologist can then prescribe medications, including SGLT2 inhibitors, to increase the heart’s pumping efficiency. But Dr Anderson says many GPs don’t do the testing or, if they do and the BNP level is elevated, they don’t do the rapid referral.
The new study, presented last week at a heart failure conference in Lisbon, analyzed data from 8,000 patients in Sweden and found that more than two-thirds of those with elevated BNP levels and symptoms of heart failure still did not have a firm diagnosis or appropriate drug treatment a year after their first visit to the doctor.
Although this is Swedish data, the UK researchers said the study also reflects what is happening here.
Dr. Antoni Bayes-Genis, another of the researchers and one of the leading Spanish cardiologists, stated at the conference: “It is a scandal. Patients go to their family doctor, take the BNP test and nothing happens. There is a huge number of deaths that could probably be avoided.
More than one million people in the UK suffer from heart failure and 200,000 new cases are diagnosed each year, according to the British Heart Foundation.
The findings mirror those of recent research by doctors at a practice in east London who followed 77 patients with symptoms of heart failure.
Although 72 percent had concerning levels of BNP, the average wait to see a cardiologist was six months or more. The researchers warned: ‘This puts patients at risk. We need a national screening program in primary care.’
A Mail on Sunday reader in his 70s wrote in earlier this month to say he was shocked to discover during a routine health check that his BNP levels were elevated.
“Now they have given me an appointment to speak by phone with a cardiologist… in mid-October,” he said. “Am I too worried that my interests are not being taken into account properly, or is this type of “treatment” normal in a post-Covid world?”
An estimated 100,000 patients a year in the UK end up needing emergency hospital treatment for heart failure, at least in part due to delays in cardiac care.
Dr Anderson and her colleagues at St George’s are now seeking funding for a trial to see whether putting patients on SGLT2 inhibitors earlier will improve their chances of survival.
- Have you been waiting for a heart failure evaluation? Write to health@mailonsunday.co.uk.