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National Health Service: handling heart failure

Posted on: 17 Dec 02
National Health Service: handling heart failure

Summary

The number of people with chronic heart failure in the western world is increasing so rapidly that, according to Datamonitor's EpiVision forecasts, by 2015 there will be 1.5 million sufferers in the UK alone. Although this is small in comparison to the 8.2 million already suffering from the condition in the US, the problem is great enough to represent a real danger for the already beleaguered NHS.
The number of people with chronic heart failure in the western world is increasing so rapidly that, according to Datamonitor's EpiVision forecasts, by 2015 there will be 1.5 million sufferers in the UK alone. Although this is small in comparison to the 8.2 million already suffering from the condition in the US, the problem is great enough to represent a real danger for the already beleaguered NHS.

With 86,000 hospitalizations per year, heart failure is currently estimated to cost the National Health Service (NHS) over £625 million a year, a figure that will rise dramatically as the number of people with the disease continues to increase.

Chronic heart failure can be a complication of virtually all forms of heart disease. Essentially, it is the inability of the heart to circulate enough blood to meet the demands of the body's tissues and is often the result of heart damage, for example following a heart attack.

Counting the cost

The disease is enormously costly for health care systems and survival rates and quality of life of those affected are extremely poor. Heart failure is extremely debilitating, substantially reducing patients' ability to carry out normal daily tasks, such as walking, climbing stairs and doing housework.

The Department of Health in the UK estimates that the current cost of heart failure to the NHS is £625 million a year, with 60% of these costs due to hospitalizations for patients with acute episodes of heart failure.

There is currently a widely documented heart failure epidemic taking place in the western world and Datamonitor forecasts that the number of people with heart failure in the UK will rise from 833,000 in 2001 to 1.5 million in 2015. This is largely as a result of the dramatic aging of the population, but is also, almost paradoxically, being driven by improvements in the treatment of cardiovascular disease.

More effective management of heart attack patients means that many patients that would previously have died now live to subsequently develop heart failure. Moreover, despite the fact that diagnosis of heart failure is often delayed and recommended treatments are widely underused, improvements in the treatment of heart failure, with the launch of new more effective drugs, has increased the number of people living with the disease.

NHS under pressure

While the increasing burden of heart failure in the UK is small in comparison to in some other countries, such as the US, where current prevalence of heart failure is estimated to be 8m and forecast to grow to over 20 million by 2015, the pressure on NHS resources will be acutely felt.

Since the majority of costs associated with heart failure are due to hospitalizations the government will be hoping to stem the rise in heart failure hospitalizations from the 86,000 per year at which they currently sit.

While government data shows that the number of heart failure hospitalizations has decreased over recent years, improving access to echocardiography, the main tool used for diagnosing heart failure, increasing the prescription of recommended drugs and improving patient management will all be extremely costly.

Although physicians interviewed in the UK estimate that approximately 60% of heart failure patients are correctly diagnosed and leading academics in the area place this figure as high as 80%, there is almost universal agreement that diagnosis is often delayed, reducing the chances of survival.

The need for testing

There are many reasons for this. Firstly, since the vast majority of heart failure patients are elderly, patients and physicians alike often attribute the signs and symptoms of early stage heart failure, such as breathlessness and swelling of the ankles, to other causes or the natural consequences of aging.

Of course, many people with these symptoms do not have heart failure, but many do and are not diagnosed until later in the disease progression. Another issue, which is particularly pertinent to the UK, is that access to echocardiography is limited and, therefore, general physicians cannot refer everyone who is at risk or who experience heart failure-like symptoms to the hospital for further diagnostic tests.

However, there is hope on the horizon as physicians and patients are made more aware of the disease. New blood tests that general physicians can use in the surgery to decide which patients need to be referred for echocardiography are becoming available. These tests should facilitate early diagnosis and treatment of heart failure, improving patients' chances of survival and reducing the likelihood of a costly hospitalization.

Despite the poor quality of life and survival rates among patients with heart failure, recommended treatments are widely underprescribed in the UK, as is the case in the US and other European countries.

Treatments underprescribed

Despite the fact that a combination of three to four drugs are recommended in treatment guidelines, Datamonitor's physician research reveals that only 16%, 54% and 79% of patients with mild, moderate and severe heart failure, respectively, receive the recommended number of drugs. This does not appear to be due to costs or lack of physician knowledge.

On the one hand, many physicians are nervous about initiating the most recent drugs recommended for heart failure, beta blockers, because these drugs used to be considered detrimental in heart failure patients, and even though a huge reduction in mortality has been demonstrated in clinical trials, patients suffer a short term worsening of heart failure in order to benefit from a longer term gain.

Britain is however, at the forefront of pioneering nurse-led heart failure clinics, where nurses monitor and support patients, educate them on their condition and the importance of taking medication as prescribed and alter drug doses as required. This approach has been shown in clinical practice and in anecdotal accounts to improve the use of beta blockers, patient compliance with therapy and patient outcomes. Despite its success, however, other countries remain way behind the UK in this respect.

The NHS' National Service Framework for coronary heart disease is also encouraging improved management of heart failure. In particular, the focus is on improving diagnosis, access to echocardiography, use of recommended treatments, establishing heart failure clinics, educating physicians and reducing hospitalizations.

Hoping for a cure

"While the growth in the prevalence of heart failure is largely due to the aging of the population, paradoxically, improvements in the treatment of other cardiovascular diseases such as myocardial infarctions (heart attacks) means that more patients are living to develop heart failure later in life," comments Christine Hollidge, cardiovascular analyst at Datamonitor.

"Despite the fact that diagnosis is often delayed and recommended treatments remain widely underused, treatment of heart failure itself has also improved dramatically, although this has served to make more people live longer with this debilitating disease rather than providing a cure."

The Policy Research Program at the Department of Health is now allocating £1 million for new research on heart failure, which is being supplemented by a further £0.5 million for the British Heart Foundation.

Research will focus on identifying factors leading to early death in heart failure patients, models of care that will improve diagnosis and treatments of patients with heart failure and analysis of how to reduce hospital admissions. How successful this will be, only time will tell. Certainly, there is room for improvement, although advances will be limited until a cure for the disease is developed.



If you found this week's Expert View useful, you may be interested in Datamonitor's reports, all available from www.datamonitor.com

  • · EpiVision: Heart Failure - Epidemiology Forecasts to 2015 priced $25,200


  • · Treatment Algorithms 2002: Heart Failure - Managing Chronic and Acute Patients priced $10,800


  • · Drugs of Tomorrow: Chronic and Acute Heart Failure- Diverse Strategies for a Complex Disease priced $6,100


  • For a free Datamonitor healthcare report please click here.

    Johan Short

    Last updated on: 27/08/2010 11:40:18

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