Diagnosis: Hospital

Key Findings

Diagnosis: Hospital

Although as many as 920,000 people are living with heart failure in the UK, there are only around 650,000 on their GP’s heart failure register.²⁴

Three quarters (74.8%) of patients received their initial heart failure diagnosis after their first hospital admission¹ – and nearly half (48.3%) of those diagnoses took place in emergency care.¹ However, a hospital visit does not guarantee an accurate – or quick – diagnosis. More than a third (34%) of these patients had gone to cardiology as an outpatient in the last six months but had not been diagnosed.¹

In 2018/19, the total number of bed days for heart failure was 862,470, equivalent to 2,362 years

According to our patient survey, nine out of 10 (93.9%) had an echocardiogram,² a diagnostic test recommended by both NICE¹⁹ and the NHS Long Term Plan as being key to early diagnosis.²⁰ According to NHS data, in 2018/19, 67,127 people received an echocardiogram during this period with a subsequent admission for heart failure.¹ However, six times more (412,323 people) received an echocardiogram with no further heart failure or other outpatient admission within 90 days.¹ With an echocardiogram costing on average £337 per patient,36 the total cost for patients who had a test with no further admission during this period was £139 million.¹

Many patients referred for echocardiography are found not to have the condition despite waiting for weeks to have the test performed;¹⁵ in 2018/19 patients waited on average 27 days between their first echocardiogram and first heart failure admission.¹ This creates a delay in receiving proper treatment.¹⁵

In 2018/19, the total number of bed days was 862,470, equivalent to 2,362 years. However, using natriuretic peptide testing (NT-proBNP) as the first step in diagnosing suspected heart failure holds the potential to make the diagnosis more accurate and efficient; reduce the number of echocardiograms; reduce the length of stay in hospital; facilitate early discharge of low risk patients and accelerate the triage of high risk patients to cardiology departments for treatment.¹⁵ Costing under £28 per test,²⁵ implementing NT-proBNP in line with NICE guidelines could save the NHS £3.8 million.³

“Failure to test NT-proBNP delays diagnosis both in the community and in the hospital setting. Late diagnosis in the community reduces quality of life and leads to emergency hospital admissions, where most patients are eventually diagnosed. These admissions are potentially avoidable and as acute heart failure carries an overall inpatient mortality of 10% there is a huge financial and human cost incurred by delayed diagnosis and treatment.

"Even in the hospital setting NT-proBNP is underused – the NCEPOD report showed that although NT-proBNP was available in 90% of Trusts, only 17% of new heart failure cases had NT-proBNP testing. This led to incorrect triage, delayed specialist review and suboptimal treatment. Most hospitalised patients experience delays for an echocardiogram to confirm the diagnosis – prolonging length of stay which is even less acceptable post COVID and in the face of rapidly increasing heart failure admissions. Delays could be reduced by using NT-proBNP on admission with early echocardiogram only for the patients who need one.”

Dr Lisa Anderson, Heart Failure Consultant, St. George's University Hospitals NHS Foundation Trust

Hannah’s story

Hannah, from Leeds, was 39 years old at the time of her diagnosis, and was originally misdiagnosed because heart failure was not thought to affect a younger person. Instead, she was checked out for anxiety. By the time she was eventually diagnosed in hospital she had dilated cardiomyopathy, by which point she had very severe symptoms and difficulty breathing. She had to live with these symptoms and a lot of uncertainty, and it had a significant impact on her family life, especially caring for children.

“I have children with special needs and not being able to look after them was incredibly difficult,” she says, “and the fact that I had to be taken away from them for 11 days because of such a late diagnosis. Had they diagnosed me sooner, I wouldn’t have been in hospital and I wouldn’t have been taken away from them in that time. I couldn't walk my children to school, so I had to get people to help me walk the children to school.”