Delays in diagnosing heart failure, with symptoms frequently mistaken for obesity, asthma, or anxiety, are causing many patients to miss out on life-saving treatments, according to medical professionals and patient advocates.
Heart failure, a condition where the heart is too weak to pump enough blood effectively, affects around one million people in the UK. While often associated with older age, it can impact individuals of any age, sometimes following viral infections or during pregnancy. The condition carries a worse five-year survival rate than many common cancers, yet diagnosis often occurs only when patients are critically ill in hospital.
Katie Denial, 24, experienced a year of misdiagnoses before her heart failure was identified. Initially told her breathlessness was a panic attack, then a chest infection, followed by asthma, her symptoms worsened, leading to severe fatigue and a 6st weight gain. GPs also suggested she was unfit and depressed. Her condition escalated to the point where she was admitted to hospital, where tests revealed her heart was functioning at only 17% of its normal capacity and her lungs were filled with fluid.
"Mortality rates are higher for heart failure than they are for any cancer apart from lung cancer," said Professor Mark Petrie, a consultant cardiologist. "And the quality of life is worse as well."
The Four-Drug Treatment
The gold-standard treatment for the most common form of heart failure, known as HFrEF (heart failure with reduced ejection fraction), involves a combination of four medications: beta blockers, ACE inhibitors, mineralocorticoid receptor antagonists (MRAs), and SGLT2 inhibitors. This therapy can significantly improve heart function, halve the risk of death, and reduce hospital admissions by approximately 70%. For Katie, the introduction of the final drug in this regimen saw her heart's pumping rate increase to 54%.
Despite the proven benefits, new figures from the NHS National Heart Failure Audit reveal that only about 50% of hospital patients with HFrEF are discharged with all four drugs. One in three hospitals missed prescribing targets for SGLT2 inhibitors, and MRA prescribing was deemed "unacceptably low."
Even for patients with HFpEF (heart failure with preserved ejection fraction), where the heart muscle stiffens, newer drugs like dapagliflozin have shown a 18% reduction in the risk of worsening symptoms and death, yet access remains inconsistent, with only 51% of eligible patients receiving an SGLT2 inhibitor.
Experts also highlight that many patients receive suboptimal doses of medication, akin to "little bits of everything, rather than effective doses," according to Dr. Fozia Ahmed, a consultant cardiologist. "We wouldn’t dream of not giving a patient with cancer effective doses of chemotherapy, but for some reason heart failure is seen as less of a priority."
Challenges in Diagnosis
Diagnostic delays are a significant barrier. If a GP suspects heart failure, a B-type natriuretic peptide (BNP) blood test can be ordered, followed by an echocardiogram to confirm the diagnosis. However, Professor Petrie notes that some patients wait "six months or even a year" for an echocardiogram. Many individuals with symptoms, even those at high risk, are not receiving the initial blood test.
Nick Hartshorne-Evans, founder of the heart failure charity Pumping Marvellous, stated that "people are dying waiting for a diagnosis." His charity, established after his own diagnosis at age 39, campaigns to raise awareness of warning signs such as breathlessness, exhaustion, and ankle swelling. The organization has helped establish rapid assessment clinics where patients can receive tests and a review within an hour.
For many, like Katie, the delayed diagnosis had life-altering consequences, including being advised against pregnancy due to the strain it could place on her heart. She now works as a patient educator, aiming to prevent others from experiencing similar delays and the subsequent impact on their lives.