Many public health campaigns focus on the importance of identifying and acting on the symptoms of major cardiovascular disease (CVD) events, such as heart attacks and strokes, as quickly as possible. Medicine has developed so much in recent decades that these events, which were once a death sentence for the majority, are now often survivable when the right care is delivered promptly by skilled healthcare professionals. The CVD community is becoming increasingly aware of the importance of early diagnosis, whether that be identifying modifiable risk factors likely to contribute to heart attacks and strokes (such as hypertension in the population), monitoring the cardiovascular health of people at increased risk due to other conditions (e.g. diabetes), or screening for congenital conditions such as familial hypercholesteremia.
There is another condition within the CVD pantheon that has not been subject to this level of public awareness raising: heart failure is a syndrome which affects over 10 million people in Europe. In a number of European countries it is responsible for more deaths than the most common cancers and has a devastating impact on quality of life. Heart failure occurs when the muscle of the heart becomes weak or stiff and cannot pump blood efficiently around the body. It can occur for a multitude of reasons, including due to damage to the heart muscle during a heart attack.
The symptoms of heart failure and the risk of hospitalisation and death can be reduced significantly through the swift implementation of guideline-recommended care, including pharmacological treatments, disease management programmes, cardiac rehabilitation and the use of cardiac devices. However, for these evidence-based interventions to take place, a person much first know that they have heart failure.
At the Heart Failure Policy Network, a multidisciplinary group of stakeholders with an interest in advocating for people with heart failure, we have come to understand that achieving prompt and early diagnosis for people with heart failure is a major pressure point for health systems. Early diagnosis can prevent deterioration and reduce hospitalisation, as well as preventing the irreversible damage to the heart that can occur when heart failure is left unmanaged. Here are two ways in which we can boost the ability of health systems to diagnose people with heart failure at an earlier stage.
1. Increase awareness of heart failure among the public and healthcare professionals
Common symptoms of heart failure, including breathlessness, fatigue and fluid retention, may develop and worsen over time in a way that allows them to be dismissed as ‘nothing to worry about’ or as an inevitable part of ageing. Many people who go on to be diagnosed with heart failure are also experiencing other conditions, such as diabetes or chronic kidney disease, so may assume their symptoms are related to these other conditions or to side effects of medications they are taking. By raising awareness of heart failure and its symptoms among the general public and healthcare professionals – especially those working in primary care, where most people with heart failure first present – we can maximise the chance that someone with suspicious symptoms will be diagnosed at an early stage.
2. Invest in community diagnostics, including point-of-care testing
Research in the UK has revealed that 80% of people with heart failure are diagnosed following a hospital admission, despite more than half of them having presented with heart failure symptoms in primary care before their hospitalisation. We also know that people who receive a heart failure diagnosis in hospital are twice as likely to die as those diagnosed in the community. Many innovations are being developed to provide fast, accurate diagnosis of heart failure in community settings. For example, point-of-care testing for a key heart failure biomarker (natriuretic peptide) was recently trialled in Norway, leading to a marked reduction in delayed diagnosis and a lowering of healthcare costs associated with repeated GP visits and other investigations, such as tests for lung disease.
With heart failure often developing as a result of other forms of CVD, raising awareness of the symptoms and of the importance of early diagnosis should be a key concern for the CVD community, especially when engaging with the public and with the primary care healthcare professionals who interact with them most.
- McDonagh TA, Metra M, Adamo M, et al. 2021. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 42(36): 3599-726
- Heart Failure Policy Network. 2018. The handbook of multidisciplinary and integrated heart failure care. London: HFPN
- Bottle A, Kim D, Aylin P, et al. 2018. Routes to diagnosis of heart failure: observational study using linked data in England. Heart 104(7): 600-05
- Lawson CA, Zaccardi F, Squire I, et al. 2019. 20-year trends in cause-specific heart failure outcomes by sex, socioeconomic status, and place of diagnosis: a population-based study. The Lancet Public Health 4(8): e406-e20
- Bugge C, Sether E, Pahle A, et al. 2018. Diagnosing heart failure with NT-proBNP point-of-care testing: lower costs and better outcomes. A decision analytic study. BJGP Open 2: bjgpopen18X101596
- Jenča D, Melenovský V, Stehlik J, et al. 2021. Heart failure after myocardial infarction: incidence and predictors. ESC Heart Fail 8(1): 222-37
