Bridging the quality gap: Heart failure

Background

Heart failure is a debilitating long-term condition affecting around 900,000 people in the UK and costing the NHS approximately £625 million each year. Heart failure is the only major cardiovascular condition that has become more prevalent in recent decades. It is responsible for dramatically reducing quality of life and carries a poor prognosis for patients, who understandably associate heart failure with an inevitable downward spiral. 

This report provides a comprehensive review of existing heart failure care by assessing quality in six domains: effectiveness, access and timeliness, capacity, safety, patient centredness and equity. It also captures the international evidence on what works to improve care, and assesses the value for money of different interventions.

The evidence in this report suggests that prevention improves patient outcomes and is the most cost-effective intervention. The economic analysis shows considerable gains from better identification and treatment of individuals with heart failure. Given this, the Health Foundation would welcome more strategic attention to be paid to heart failure, particularly around prevention and screening. 

About this report

Key insights from the report include the following:

• There is a wealth of evidence on heart failure and a number of clinical practice guidelines – survival rates are improving and waiting times for diagnostic tests are falling. However, the data suggests that heart failure services in England have been slow to improve over the last decade and still lag behind their international counterparts.
• Heart failure monitoring services are not meeting guideline requirements. Healthcare Commission data shows that only 49% of NHS organisations had guidelines that meet minimum requirements for monitoring, and 66.5% had local guidelines on monitoring intervals consistent with NICE guidance.
• Waiting times for echocardiography (ECG) have fallen dramatically since 2006.
• Data suggests that hospital admissions for heart failure patients are relatively fewer than comparator countries. However, once admitted, heart failure patients stay longer in hospital.
• A minority of heart failure patients are admitted to cardiology wards in England, but those admitted to specialist units receive higher quality care.
• Recent decades have seen an overall decline in mortality from coronary heart disease but ,as heart failure occurs predominantly in older people, the number of patients with heart failure is increasing as the population ages.
• Better identification and treatment of everyone with heart failure would reduce the numbers of avoidable deaths and result in an increase in quality adjusted life years.
• There are relatively low levels of compliance with evidence-based guidelines. The evidence shows that, in 2008/9, more than half of patients hospitalised with heart failure (whose prescribing information was noted) were not prescribed beta-blockers, and one fifth were not prescribed ace inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs).
• Very few heart failure patients receive cardiac rehabilitation. A British Heart Foundation audit of the cardiac rehabilitation programme found that only 1% of participants had been diagnosed with heart failure.

Who should read this report?

This report is designed to inform those with an interest in improving heart failure services.