Bridging the gap in heart failure detection, diagnosis and treatment

Around 920,000 people in the UK have been diagnosed with heart failure (HF), which is a complex clinical syndrome where the heart does not pump blood as effectively as it should. HF commonly develops over time, but signs and symptoms can appear suddenly, with patients often experiencing several acute episodes leading to unplanned emergency hospital admissions. These can lead to a further deterioration in health.

However, there are also around 138,000 undiagnosed HF patients in England who would benefit from treatment. In July 2021, ICHP launched a new dashboard which uses real-world data to help identify gaps in HF detection, diagnosis and treatment, broken down by geographical region in England. It provides health professionals with data and insights for their local health systems, providing the evidence they need to introduce changes that will have a positive impact on patients’ lives. In North West London (NWL) the Discover dataset can be used to effectively deep dive into the outputs identified by the dashboard.

HF has been identified as an area of cardiac care where improvements in diagnosis and treatment can be made. Around eight out of 10 heart failure diagnoses in England are made in hospital, however studies show that around half of these patients experience symptoms that should have been picked up by an earlier assessment in the community.

Potential issues leading to emergency admissions and diagnoses made in hospital include a lack of awareness of heart failure diagnostic pathways and a potential lack of HF specialist services

ICHP was approached by a pharma company for a tool that clinicians can use to look at what is happening in their area around diagnosis and treatment. They can then focus in to see where the biggest gaps in the patient journey are and what the impact would be if patients were found, diagnosed appropriately and put on optimal treatment utilising user data in the tool.  The aim is to use the data to put together a business plan to address the issues.

The dashboard uses quality outcome framework (QOF), hospital episode statistics (HES) and ePACT prescribing data to highlight opportunity gaps, allowing healthcare professionals to see the following stats for their clinical commissioning group (CCG):

• Number of patients potentially undiagnosed with HF
• Number of patients not diagnosed according to guidelines
• Number of patients not receiving adequate treatment.

If HF is identified and treated correctly in the community, admissions should reduce, saving both lives and money for healthcare systems. The model used shows systems the impact that they could make through implementing appropriate changes to their services and that while treatment costs may go up, overall costs decrease and mortality should improve.

Once any opportunity gaps have been identified, the dashboard allows clinicians to model the effect on both mortality and cost of applying high impact interventions in their local area, building the data evidence needed to create an impactful detection, diagnosis and treatment plan.

Healthcare decision makers can see how many people are predicted to be on their HF register as well as how many are already on their HF register, and therefore can identify how many patients they need to find to close the detection and treatment gap. This could include demonstrating that not enough patients are on the right treatments, a lack of clinicians working in HF, or a shortfall in diagnoses compared to the prevalence across the UK.

The dashboard gives data at a CCG area level, however systems can use their own data to deliver a deeper dive into any issues. In NWL this is possible through the Discover dataset, which provides a deidentified linked primary care, acute, mental health, community health and social care record for over 2.4 million patients who live and are registered with a GP in NWL. This dataset is fed by data from over 400 provider organisations including 360 GP practices, two mental health and two community trusts and all acute providers attended by NWL patients.

Local data allows clinicians and commissioners to decide what they want to work on, break down any issues into smaller, more manageable improvement projects and to identify which parts of the patient journey are working well.

The dashboard has been shared at a national level with bodies including the British Society of Heart Failure, the British Heart Foundation, and the national cardiac clinical networks. It has also been shared at an NWL level with specialist cardiovascular disease clinicians and heart failure specialists.

Feedback has been that this tool is unique and very useful for clinicians and commissioners to see where they need to do a deep dive and work in their local area on what is going well and not so well.

Work is also underway through another academic health science network looking at coding in primary care to see if this has an impact on the data, links to this tool will be incorporated into the dashboard.

Instructions and a user guide for the HF dashboard can be found here.