Delays in diagnosing heart failure are common, with symptoms often misattributed to less serious conditions, leading to worse prognoses for patients, according to a report in the Daily Mail.
Katie Denial, a 24-year-old at the time, experienced breathlessness and fatigue but was repeatedly told by her general practitioners that she had a panic attack, a chest infection, asthma, or was unfit and depressed. She gained significant weight and found it difficult to lie down, experiencing symptoms indicative of fluid buildup. It took a year of worsening symptoms, including her skin turning yellow, before an ambulance was called, leading to a hospital diagnosis of heart failure.
Heart failure, a condition where the heart is too weak to pump sufficient blood, can affect people of any age. While often associated with older individuals, approximately 100,000 people under 50 in the UK are living with the condition, a number that has been growing. This increase is linked to rising rates of obesity, type 2 diabetes, and high blood pressure in younger demographics. In younger individuals, causes can also include genetic conditions like dilated cardiomyopathy or viral infections.
Misdiagnosis and Its Consequences
Experts note that many patients are not diagnosed until they are critically ill and admitted to emergency departments. Data suggests that approximately 60% of heart failure diagnoses occur in this manner. Patients diagnosed after hospitalization face a 2.5 times higher risk of dying within the first year compared to those diagnosed earlier. The prognosis for heart failure can be worse than for many common cancers, with a poorer quality of life.
Once diagnosed, effective treatments, particularly a four-drug combination known as the 'four pillars,' can significantly improve symptoms and heart function. These drugs include beta-blockers, ACE inhibitors, mineralocorticoid receptor antagonists (MRAs), and SGLT2 inhibitors. This combination can halve the risk of death and reduce hospital admissions by about 70%. However, recent figures from the NHS National Heart Failure Audit indicate that only about 50% of hospital patients with heart failure with reduced ejection fraction (HFrEF), the type where the heart has a weakened pump, are discharged on all four drugs. Access to newer drugs like SGLT2 inhibitors for other forms of heart failure is also inconsistent.
Challenges in Diagnosis
GP Clare Taylor highlighted that some patients, particularly older ones, may dismiss their symptoms as a natural part of aging. The diagnostic process itself can be lengthy. A suspected case of heart failure can be initially assessed with a blood test for B-type natriuretic peptide (BNP), followed by an echocardiogram. However, patients can wait six months to a year for these tests. Furthermore, the initial blood test is not always administered, even to at-risk individuals. Research has shown that one in four people with diabetes and another risk factor for heart failure had undiagnosed heart failure.
Charity Pumping Marvellous, founded by Nick Hartshorne-Evans who was diagnosed with heart failure at 39, campaigns for greater awareness of warning signs like breathlessness, exhaustion, and ankle swelling. The charity has helped establish one-stop clinics where patients can undergo blood tests, heart scans, and reviews in a single visit, significantly speeding up the diagnostic process. In contrast, Katie Denial's journey to diagnosis took a full year.
Impact on Patients
The delayed diagnosis and the severity of heart failure can have life-altering consequences. Due to the strain pregnancy would place on her heart, Katie Denial was advised against having children, a prospect she had to grieve. Unable to work and experiencing depression, she found support through an online community. While her heart function has improved with treatment, she continues to manage the long-term effects of the condition, adapting her life to her health limitations. She now works as a patient educator, aiming to prevent others from experiencing similar diagnostic delays.