CARDIOLOGY
Heart failure diagnosis: gender gap revealed
Using new analysis of 2018/19 Hospital Episodes Statistics and patient survey findings, a new report reveals that while men surveyed waited on average 3.6 weeks for their diagnosis from their initial GP visit, women waited on average just over 20 weeks – a near-six-fold increase.
Female patients are waiting significantly longer to be diagnosed with heart failure than men, a new report has revealed, with delays associated with poorer quality of life, financial losses, mental health issues and avoidable deaths.
An early and accurate diagnosis of heart failure is critical to ensuring rapid access to treatment, reducing the risk of long- term complications and preventing early deaths. Heart Failure: The Hidden Costs of Late Diagnosis, by Roche Diagnostics and leading heart failure charity, the Pumping Marvellous Foundation, analyses patient survey findings from Censuswide and 2018/19 Hospital Episode Statistics. It highlights the missed opportunities of diagnosis and the staggering reality of some patients’ experiences. The report illustrates a number of the ‘hidden victims’ of heart failure, including female patients who are 96% more likely to be misdiagnosed than men. While 44.5% of women surveyed said they were initially misdiagnosed, just 22.7% of male patients said the same. The most common misdiagnoses among women were asthma (30.4%), anxiety or depression (22.4%) and acid reflux (13.6%).
It also shows that while men said they waited on average 3.6 weeks for their diagnosis from their initial GP visit, women waited on average just over 20 weeks – a near-six-fold increase. More than one in 10 women (10.7%) spent more than six months waiting for their heart failure diagnosis. Women are also more likely to hold off making an appointment with their GP after first developing symptoms, with 13.2% of those surveyed waiting longer than four months compared with 5.8% of men. Experts say the stark inequalities could be down to heart problems too often being seen as ‘a man’s disease’ and heart failure not being prioritised in the same manner as
NOVEMBER 2020
other disease areas, like cancer. Sarah, from Hull, was 42 when she was diagnosed. She visited her GP multiple times over a 10-month period and was misdiagnosed with rheumatological concerns, despite the fact her father had a heart condition and she had Type 1 diabetes, a common comorbidity. She said: “My GP never mentioned that they thought I might have heart failure. In fact, one of them actually said, your symptoms are probably not to do with your heart because you’re young and you’re female. Even though my father had had a heart condition and even though I’ve been Type 1 diabetic for 40 years, it was never considered.” The report reveals that the route to
heart failure diagnosis is often long and convoluted. According to NICE guidance for both chronic and acute heart failure, doctors should take a detailed history and perform
a clinical examination and tests.1
NICE
recommends NT-proBNP – a simple blood test which costs less than £28 – to help rule out heart failure.2
Patients who are not ruled
out can then be sent for an echocardiogram to receive a formal diagnosis. But failure to associate signs and symptoms with heart failure, and the variable uptake and usage of NT-proBNP testing by healthcare providers in clinical commissioning groups (CCGs), can lead to inappropriate echocardiogram referrals – each costing on average £1,430 per patient in 2018/19.
It also means tens of thousands of patients are being diagnosed in hospital unnecessarily. According to the report, 87,580 patients, whose primary diagnosis was heart failure, visited hospital in 2018/19. Three quarters (75%) of these patients received their diagnosis during their
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