Improving care pathways – examples from cardiovascular disease

Why optimise the heart valve disease pathway?

Cardiovascular disease (CVD) is group of interrelated conditions which are responsible for a quarter of all deaths in the UK.¹

Among these deadly conditions is heart valve disease (HVD).

If diagnosed early, HVD can be treated effectively with heart valve replacement or repair before a patient’s condition deteriorates. Unfortunately HVD is notoriously underdiagnosed, frequently going unnoticed or mistaken for ageing by patients and clinicians. For many patients, the condition is identified simply too late to benefit from treatment. Inadequate detection, late treatment or no treatment, often results in a devastating outlook for patients.

Five-year survival rates for some forms of severe HVD, such as severe symptomatic aortic stenosis (AS), are poorer than many common metastatic cancers in the UK,² and about 50% of people with the condition who do not receive effective or appropriate treatment do not survive two years.²

The NHS faces a number of challenges with HVD:

• Poor recognition among healthcare professionals
  Common symptoms, like breathlessness and reduced exercise tolerance, may be attributed to advancing age.
• Reduced opportunities for chest auscultation
  The first step to HVD diagnosis is identification of a heart murmur. This requires chest auscultation; however, reduction in face-to-face appointments during the COVID-19 pandemic and increased overall pressure on GP services limits opportunities for HVD detection.
• Strain on echocardiography
  Patients with a heart murmur are referred to echocardiography for diagnosis. However, echocardiography service capacity is under enormous strain. The NHS is struggling to retain, recruit and train staff, leading to increased pressures on the existing workforce and significant backlogs.
• Long waits for life-saving treatment
  Increased capacity is needed in specialist heart centres to ensure treatment can be delivered on time. Patients often face long waiting times to access the treatment they need. All the while, the condition deteriorates and the chance of a good outcome fades.

References

1. British Heart Foundation. Facts and figures. 2022. Available at: https://www.bhf.org.uk/what-we-do/ news-from-the-bhf/contact-the-press-office/facts-and-figures (accessed March 2023).
2. Ali N, Faour A, Rawlins J, et al. ‘Valve for Life’: tackling the deficit in transcatheter treatment of heart valve disease in the UK. Open Heart 2021;8:e001547.