DIAGNOSTICS
proBNP) – a simple, cost-effective blood test which can help to rule out heart failure – is recommended by NICE,8
but access to it is
inconsistent across the country. It can be used in both primary and secondary care, but is used less commonly in primary care.5 The earlier a diagnosis is made, the better the outcome – while earlier testing in primary care can help to reduce the need for unnecessary echos and referrals, and unplanned hospital admissions.9
Using the
right diagnostic tool, at the right time, helps to streamline the patient pathway and enable improved patient management further down the system. Dr. Jim Moore, a GP with special interest in cardiology and president of the Primary Care Cardiovascular Society, is clear about this: “Primary care has a crucial role to play in making an early diagnosis of heart failure which is associated with an improvement in quality of life and long-term outcomes. The presenting symptoms of heart failure are non-specific and commonly seen in other conditions, but there is evidence that this diagnosis is not being considered at an early stage where investigations such as NT-proBNP testing are critical to further assessment and, where appropriate, urgent onwards referral.” Heart failure often struggles to get its voice heard in comparison to cancer. But it has worse survival rates than breast, prostate and bladder cancer, and mortality rates remain significant, particularly in areas of social deprivation.6
The good news is that there are new therapies in the pipeline for heart failure, which will be navigated by new cardiac biomarkers. One recent study in Scotland showed that by using innovative digital and AI techniques, it is possible to cut waiting times for people with suspected heart failure from almost 12 months to less than 12 weeks.10
The introduction of Integrated Care Systems (ICSs) in England, which will feature specialist cardiac care, is a real opportunity to improve the uptake of diagnostic tests for heart failure and the experience of this growing group of patients. An opportunity which is also called out in the Long Term Plan, which highlights that taking a proactive population health approach, “will also enable earlier detection and intervention to treat undiagnosed disorders, such as heart failure”.11 This structural shift in the way that the NHS operates will help to stitch together innovation and collaboration, leading to primary and secondary care working together more smoothly, along with tertiary services and laboratories.
These systems are likely to go through a lot of refinement, but they offer much promise if we can build on the spirit of collaboration and the pace and agility with which health services and industry have come together to respond to COVID-19.
The power of collaboration The pandemic has demonstrated how fortunate we are to have the NHS – and the strong architecture this provides to ensure continuity of care and enable resilience during the most challenging times. It has also demonstrated the power of partnership working like never before and we have a responsibility to build on this as we move beyond the pandemic. Women’s health is rightly high on the agenda, and the Government has consulted on a new Women’s Health Strategy. Pre-eclampsia affects around 3% of pregnant women, and it can lead to serious complications if not monitored and treated. Better diagnosis of pre-eclampsia ultimately improves patient safety, removes unnecessary anxiety and reduces the burden on maternity services. Placental Growth Factor (PlGF)-based testing, a blood test which can confirm or exclude pre-eclampsia in pregnant women, had previously been selected as one of seven rapid uptake products by NHS England’s Accelerated Access Collaborative (AAC), designed to identify highly transformative innovations and to make them more widely available. This test is now being used by hospitals across the country, including Trusts in Greater Manchester which are using it in all their maternity units thanks to support from Health Innovation Manchester.12 Professor Jenny Myers, consultant obstetrician and professor of obstetrics and maternal medicine at The University of Manchester, said: “The Placental Growth Factor test enables us to make the right decisions for the women in our maternity care. We can ensure that those with pre- eclampsia or who are at the highest risk of developing pre-eclampsia are getting the care they need, when they need it.” There is so much we can already do, using the right diagnostic test, at the right time, to enable swift decision-making. But there
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