1. Improved education on the signs and symptoms of heart failure in primary care
To ensure people with heart failure receive a timely diagnosis, Health Education England should provide GPs with enhanced education and training to identify the signs and symptoms of heart failure.  They should also be supported to follow NICE guideline NG10619 which recommends taking a detailed patient history, performing tests to confirm the presence of heart failure and measuring NT-proBNP in those with suspected heart failure.
2. Easier access to tools to aid swift and accurate diagnosis in primary and secondary care.
Clinical commissioning groups (CCGs) should be incentivised to commission diagnostic tools such as NT-proBNP testing and echocardiography in primary care – as recommended by NICE – to improve the early detection of heart failure. Enabling and encouraging GP practices to test in greater numbers could improve diagnosis in the community, thereby accelerating access to treatment for those at high risk and reducing the number of unnecessary hospital referrals and inpatient stays for those with a low NT-proBNP who can be ruled out as having heart failure.
3. More consistent use of natriuretic peptide testing (NT-proBNP) in hospitals.
Evidence shows that NT-proBNP testing, as the first step in diagnosing suspected heart failure, holds the potential to make the diagnosis more accurate and efficient and has the potential to reduce costs for the NHS. Secondary care should also ensure consistent use of these vital tools to aid heart failure diagnosis.
6. Prioritise heart failure post-COVID-19.
In light of the increased risk of people with heart failure falling seriously ill from COVID-1916 – in addition to the increased incidence of COVID-19 in those hospitalised for heart failure9 – it will be crucial that heart and circulatory diseases are considered a priority in any national, regional or local post-COVID recovery plans as normal services are resumed within the NHS.
4. More work to reduce gender inequality in heart failure diagnosis.
Greater awareness of the inequality in the diagnosis and misdiagnosis of heart failure will be critical to closing the gender gap and improving the diagnosis, outcomes and experience of women living with heart failure.
5. Appropriate signposting to emotional and social support for heart failure patients.
To enable heart failure patients to experience less stress and anxiety around their diagnosis, patients should have access to appropriate emotional support. That could include timely signposting to psychological therapies, social support and patient and peer support groups such as the Pumping Marvellous Foundation. In this time of particular need, it is all the more vital for patients to have access to well-moderated communities which are coming under increasing pressure in the context of COVID-19.