GPS missing heart failure cases amid ‘target culture’ in NHS
36pc
TWO thirds of cases of deadly heart failure are being missed by GPS amid warnings that an NHS target culture is helping cause a “medical emergency”.
Leading cardiac experts said women and older patients were faring worst amid “dangerous” failures to spot the life-threatening condition, which can be treated with cheap pills.
The study of almost 100,000 NHS heart failure patients found that the vast majority were only diagnosed after having been admitted to hospital – by which time they were more likely to have become gravely ill.
The Oxford University research, which tracked patients for more than a decade, found a steep decline in the proportion of cases identified by GPS.
The study found that in 2014, just 36 per cent of patients with heart failure were diagnosed by their GP, or after referral by their family doctor to an outpatient clinic. This was a fall from 56 per cent in 2002.
Researchers said the NHS “pay for performance” scheme for GPS, introduced during the period, appeared to be contributing to the failings – because
The proportion of cases of deadly heart failure that were caught by GPS in the NHS in 2014
key tests are not linked to financial rewards.
Martin Cowie, professor of cardiology at the National Heart and Lung Institute at Imperial College London, said lives were being cut short by a litany of failings in diagnosis and treatment.
He said: “This is a medical emer- gency. We need to wake up and get our house in order.”
Even after being discharged from hospital, just 14 per cent of heart failure patients received the follow-up care they should have received from GPS, the research found – a drop from 20 per cent in 2002.
The vast majority of patients were on far too low doses of drugs, which cost as little as 3p a day, the study, presented at the European Society of Cardiology Congress in Munich, found.
Almost one million people in the UK suffer from heart failure, a condition that occurs when the heart muscle is too weak to pump blood round the body, causing breathlessness, fatigue and premature death.
Since 2010, GPS have been advised to offer patients at risk of the condition a specific blood test, which costs the
NHS about £20 each. But in 2014, just 23per cent of patients got this check, the research reveals.
Prof Cowie, one of Britain’s leading experts on heart failure, urged GPS to “get the basics right”.
“Usually it takes the patient going back several times, or getting so bad that they are admitted to hospital,” he said.
“We need a spotlight shone on these issues. We are failing our patients.”
Separate data shows that more than one third of those diagnosed after being admitted to hospital are dead within a year – compared to one in five cases among those detected earlier.
The new research, funded by the British Heart Foundation, shows that elderly people and women waited longest for a diagnosis, and were respectively 15 and 9per cent less likely than other patients to be diagnosed without hospital admission.
Nathalie Conrad, a researcher from Oxford University, said the introduction of the new pay system for GPS in 2004 appeared to have contributed to the decline.
“The system is not designed to really incentivise GPS to do screening of heart failure and to actively pick up on patients who come from hospital,” she warned.
Next month Nice will issue new guidance, reminding GPS to ensure patients at risk of heart failure get the right checks.
Health officials are so concerned about failings in cardiac care that they intend to make it a priority of the NHS 10-year plan, due to be published later this year.
Dr Mike Holmes, vice chairman of the Royal College of GPS, said early symptoms of the condition could be hard to spot within a standard 10-minute consultation.
A spokesman for NHS England said the study had shown some improvements in ensuring patients got the right investigations when warning signs were spotted.