Care of heart failure patients falling short in the UK

Care of patients with heart failure in the UK is inadequate and has not changed in a decade, according to new research published in BMJ Open.

The findings by a team at Durham University and Darlington Memorial Hospital - and funded by national charity Heart Research UK - highlight inadequacies in heart failure care as well as an uncoordinated approach to diagnosis and management of the condition between primary and secondary care clinicians.

The research showed that clinicians are uncertain about how to diagnose different types of heart failure and about who has overall responsibility for heart failure management.

There was also inconsistency in patients' access to tests and services and a lack of awareness by of dedicated heart failure clinics. Health professionals expressed concerns about how to care for heart failure patients affected by other diseases and taking other medicines.

Over 750,000 people are living with heart failure in the UK.

Lead investigator, Professor Ahmet Fuat, Honorary Clinical Professor in the School of Medicine, Pharmacy and Health at Durham University, said: "Overall, staff told us that they were unsure of who had overall responsibility for heart failure from the point of diagnosis through to the end-of-life.

"Even though the government has spent a lot of money on improving heart services, some of the problems we were told about are the same as those found ten years ago. This is worrying because it means we are still not getting things right for patients with heart failure."

The researchers recommend the development of clear lines of responsibility, better education of GPs and non-heart specialist hospital doctors, and that the same high quality services and care pathways are available to all patients.

The project, led by a team from Durham University's School of Medicine, Pharmacy and Health, looked at how clinicians diagnose and care for patients with heart failure, an increasing problem that affects about a million people in the UK but often goes undetected and under-treated.

The study involved interviewing GPs, cardiologists, physicians and heart failure nurses in small focus groups, and used the information to carry out a survey of 500 clinicians to compare heart failure care across the UK.

The diagnosis and treatment of heart failure is complicated and can lead to large differences in care. If diagnosed and treated properly, the symptoms of heart failure can be well controlled and the length and quality of life improved. New treatments are carefully assessed in clinical trials but there is very little research afterwards looking at the way care is delivered.

Barbara Harpham, National Director of Heart Research UK said: "As more people survive heart attacks and with the aging population, the incidence of heart failure is going to soar and, from this study, it appears that heart failure management and care have not kept pace. The challenge is out there – there needs to be uniform care across the country and everyone involved has to change to give the best to their patients."

The study findings will be used to develop further research to improve diagnosis and care for patients in the areas of GP education, end-of-life care, and care pathways for diagnosis and management.

More information: 'Barriers to accurate diagnosis and effective management of heart failure have not changed in the past 10 years: a qualitative study and national survey', Fuat et al, published in BMJ Open (2 April 2014), bmjopen-2013-003866.R1

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