Covid-19 has proven a seismic event for our societies, and it is easy to forget that the pandemic will not dominate the debate on healthcare forever. Yet by any rational measure, efforts to manage long-term conditions will continue to be responsible for the majority of healthcare costs into the future.
Heart failure (HF) is, and will remain, one of these crunch issues. Simply put, we have very little choice but to pursue the timely prevention and care of HF, due to the sheer scale of the disease and the high price attached to failure, both human and economic.
HF occurs when the heart is unable to pump enough blood to meet the body’s needs, resulting in a heavy physical and psychological burden. Outcomes are often poor, including mortality and quality of life. In fact, HF is the most common cause of hospital admissions in people over 65 and the leading contributor to unplanned hospital readmissions overall.
Yet few political leaders across Europe appear to grasp that HF is a major battle ground for preventable morbidity, mortality and cost. Rapid access to effective diagnostics and the best use of diagnostic information are essential to reducing the burden of HF. Therefore, we welcome MedTech Europe’s case study exploring how the information generated by in vitro diagnostics can help to improve HF care, and in particular by cardiac biomarkers such as natriuretic peptides (NP testing).
Unfortunately, the use of diagnostic information for HF is routinely suboptimal in many European countries. Poor multidisciplinary working, misdiagnosis, lack of capacity and inconsistent application frequently lead to harmful delays, meaning HF is often confirmed late, after severe damage to the heart has occurred.
Bottlenecks are commonplace for echocardiography, the specialist-led ‘gold standard’ diagnostic test, and key tools such as NP testing are still not fully reimbursed or recommended by national guidelines, despite recognition in European guidelines. For example, in England, a 2016 parliamentary report estimated that one-third of GPs and one-third of hospitals do not have access.
Decision-makers need solutions, not problems, and NP testing has considerable potential. As a case in point, in 2016 the Irish Cardiac Society estimated that NP testing could reduce demand on specialist diagnostic services by 30%, a huge opportunity to generate streamline resources to those who need it.
Models of HF are changing for the better – often thanks to individual centres, leaders and pilot programmes. The problem is that it is happening fast or consistently enough in the mainstream. As a community of advocates, we need to present a unified policy case for change orientated around these models, with diagnostics and the information they generate fitting seamlessly into them.
We must also push for a new generation of government strategies to shape a better environment for success in HF, which include urgent changes to the workforce and the enablement of greater clinical delegation to nurses and others allied health professionals. To win the case for investment, we need realistic commentary on outlay, and return, that works on a political timescale. We should also generate and scrutinise outcomes data to ensure countries that go on to succeed in moving the needle on cost and outcomes are recognised as leaders.
It is true that COVID-19 has not made this any easier. But it has also reminded us of the vulnerabilities faced by people living with long-term conditions, and that our duty to maximise their health and wellbeing is of very real consequence to us all.