Disjointed and unequal care, likely exacerbated by the Covid-19 pandemic, is leading to more people dying with heart failure, according to a new report from the British Heart Foundation (BHF). 
The report, Heart Failure: A Blueprint for Change, reveals that prior to lockdown, UK hospital admissions for heart failure had risen by nearly a third  over the last five years to more than 100,000 per year.
This could be in part due to missed opportunities to diagnose and treat people with the condition before they become more unwell and need to be admitted to hospital.
This is supported by research cited in the report that found that 80 per cent of people with heart failure are diagnosed in hospital, even though 40 per cent visited their GP in the previous five years with symptoms such as breathlessness, swollen ankles and exhaustion . Patients diagnosed in hospital have more advanced disease and therefore significantly worse outcomes. Earlier diagnosis can therefore save lives. 
The condition, although complex, can be diagnosed in the majority of cases through a simple blood test and echocardiogram – both of which could be done in GP surgeries, or elsewhere in the community. The report calls for these tests to be more readily available to GPs. 
The Covid-19 pandemic has likely intensified these problems. Latest data shows hospital admissions due to heart failure decreased by 66 per cent by the end of May in England compared to the previous year.
However, there is limited information about how many patients have accessed care and support, if at all, during this period . The BHF is concerned that many people with heart failure have fallen through the cracks of the NHS since lockdown began, adding to the picture of disrupted and fragmented care.
The charity says that the multitude of issues in heart failure care is leading to needless and avoidable pressure on the NHS and has tragic consequences for patients. Nearly half of people diagnosed with heart failure die within five years of their diagnosis , but the mortality rate can vary according to geography, ethnicity and socioeconomic background, suggesting there are missed opportunities for improvement. 
To address the heart failure care crisis, the BHF has laid out a “blueprint for change,” which it says would improve care standards and alleviate pressure on the health service if implemented.
Professor Sir Nilesh Samani, Medical Director at the British Heart Foundation, said: “There is no cure for heart failure, but decades of research have given us treatments that allow people to live longer and have a better quality of life with this condition with the right care and support. The key is earlier diagnosis and treatment. 
“As our new report finds, too many people are falling through the cracks of our system – a result of stark disparities in heart failure care, likely made worse by the Covid-19 pandemic. This is making people more unwell, causing mental distress, and needlessly costing lives.
“As the NHS recovers from the first wave of coronavirus and prepares for its resurgence, it is vital that, as a priority, we not only switch heart failure services back on again but build them back better. 
“By diagnosing people with heart failure early, getting them the specialist care they need, and joining up services to help them avoid admission to hospital, we can relieve some of the unsustainable pressure on the health service, and help more people with this serious condition live well for longer.”
The BHF says it is crucial that there are significant changes to the way heart failure services are delivered across the UK. It has laid out a series of recommendations, which all share a common theme: the need for joined up heart failure services that are equipped to support patients all the way through from diagnosis to end of life care. 

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