Dr Carly Schott, market manager, cardiology and critical care, Roche Diagnostics UK & Ireland writes about how COVID-19 is a ticking time bomb for heart failure patients, and how improved of existing tools can save lives.
Heart failure affects almost one million people in the UK. Although it is described as a modern-day epidemic, with worse survival rates than breast, prostate and bladder cancer, it is not prioritised in the same way as other diseases. COVID-19 is creating a ticking timebomb for these patients who are at increased risk of complications and poorer outcomes due to a COVID-19 infection. However, unlike some diseases, there is a simple and cost-effective solution to diagnose heart failure early. This can ensure that patients receive appropriate treatment and care, prevent unnecessary stress, pain and suffering, and ease the burden on the NHS.
As NHS service delivery and patient access is reconfigured post-COVID, it will be critical to use effective diagnostic testing to help unlock capacity, manage an increase in demand and reduce the cost burden. This includes diagnostic solutions such as NT-proBNP – a blood test costing less than £28 that rapidly rules out heart failure. COVID-19 has taught us the value of testing in delivering the right care at the right time. With tens of thousands of people diagnosed with heart failure in hospital unnecessarily, and fewer than half of all heart failure patients surviving five years after their diagnosis, we must now give greater priority to the role of testing in other health conditions to alleviate pressures, improve outcomes and address the unwarranted variation in access to care.
The heart failure challenge
Heart failure diagnosis in the UK is often long and convoluted. Heart Failure: The Hidden Costs of Late Diagnosis, a new report by Roche Diagnostics and the Pumping Marvellous Foundation, has found that three quarters of patients received their initial heart failure diagnosis after a hospital admission in 2018/19, and almost half of those diagnoses took place in emergency care. Almost one in five who were admitted during the same period died within six months of their admission. These findings paint a bleak outlook for heart failure patients, compounded by the significant social and economic impact of a delayed diagnosis.
Diagnostic tools
Although the pandemic has highlighted the crucial importance of access to rapid and accurate diagnostic tests, the uptake and use of NT-proBNP is poor, despite being recommended in European Society for Cardiology guidelines as well as NICE guidance for both chronic and acute heart failure. As the first step in diagnosing suspected heart failure, NT-proBNP holds the potential to rapidly rule it out, reduce unnecessary echocardiograms and length of stay in hospital. When heart failure isn’t ruled out, the patient can be triaged to cardiology while those without heart failure can be rapidly diagnosed and treated for the right condition. With heart failure accounting for 862,470 bed days in 2018/19 and admissions costing nearly £400 million over the same period, diagnostics also hold the potential to unlock capacity and reduce NHS costs. Routine commissioning of this test could help deliver a 50% reduction in likely unnecessary echocardiograms and referrals, saving the NHS £3.8 million.
With NT-proBNP recommended by NICE to facilitate a timely heart failure diagnosis, detection should not be about ‘luck’ or location but available to all those presenting with the most common signs and symptoms of heart failure – breathlessness, swollen ankles and legs, and increased fatigue. However, one in five patients surveyed for the report were not offered a blood test for heart failure at any point during their journey to a diagnosis.
A consistent solution
A lack of a mandate or dedicated funding for the use of diagnostics – unlike pharmaceuticals – means that even for products deemed highly innovative and cost-effective, uptake and spread are often low and slow. In fact, the UK spends only £10 per capita on IVD products, less than half of spend per capita in France, Germany and Italy. New structures to accelerate adoption of diagnostics have been created, including AHSNs, the Accelerated Access Collaborative and the Innovation and Technology Payment (ITP) programme, which ringfences funding for NHS Trusts to implement ground-breaking new products. Last year’s ITP included high-sensitivity troponin, a blood test which enables doctors to rule out suspected heart attack within three hours – nine hours faster than the current rate. While these initiatives are encouraging, to support uptake at scale, focus must be targeted towards local resourcing, capability and capacity. The value of diagnostics in delivering clinical outcomes and NHS sustainability should also be enshrined in national policy so that patients are consistently diagnosed earlier and – where possible – in the community to reduce pressure on hospital services.
The urgency to prioritise innovative technology like NT-proBNP only becomes greater as we look towards the future challenges posed by COVID-19. Clinical Commissioning Groups (CCGs) should be incentivised to commission diagnostic tools in primary and secondary care to ensure consistency of access across the country, whilst the formation of Primary Care Networks should enable GP practices to work together to tackle heart failure and test in greater numbers. This would 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. The report also calls for more consistent use of NT-proBNP in hospitals, while emphasising the need to prioritise heart and circulatory diseases in any post-COVID recovery plans.
As we move towards the winter months and continue to see significant changes in service delivery, patient access and care, making a timely and accurate diagnosis only becomes more important. The government is right to prioritise building a stronger UK diagnostics industry for the future, but this must include investment in existing clinically-proven diagnostics to help strengthen and future-proof the sector. The consistent and widespread use of cost-effective diagnostic tools such as NT-proBNP must be a priority to save lives, reduce unwarranted variation, support the NHS and improve quality of life and outcomes for all patients, now and in the future.
