Cardiology
earlier, particularly with the high availability of diagnostics. An NT-proBNP blood test, a simple and accessible biomarker that indicates heart abnormal pressure on the heart, is the main diagnostic tool that can help rule out heart failure in patients presenting with common symptoms. The test also enables faster triage of patients who require urgent referral to a specialist or confirmation of a diagnosis through using echocardiography. Primary care faces increasing pressure.
However, changing the narrative around its role is essential if we are to address the rising burden of heart failure. Fully utilising its existing diagnostic tools and shifting from a reactive to a proactive model are crucial for developing a modern heart failure service capable of managing the increasing caseload. As our report will demonstrate, some parts of the health service are already making progress in this direction.
Improving time to diagnosis: towards a proactive, community approach Earlier diagnosis in primary care is one area that has enormous potential to reduce the growing burden of heart failure, and should be a priority for both national and local commissioning. Studies have found that improving diagnosis in primary care alongside optimal management in the community can reduce hospitalisation by up to 30%.2
But how can we achieve this
through practical steps that support the already stretched primary care workforce? One highly effective initiative — drawn from the success of the FAST acronym for strokes — is the use of the Pumping Marvellous BEAT acronym. This straightforward heuristic, which stands for Breathlessness, Exhaustion, Ankle- swelling, and Time for a test, aims to raise awareness of symptoms and prompt a thorough assessment using an NT-proBNP blood test. At
the very least the Alliance advocates for this acronym and its resources to be implemented in primary care settings nationwide, something recognised by the Health Innovation Network who have included it in their two-year national heart failure plan. But building the appropriate diagnostic
capacity and awareness must extend beyond GP surgeries. One aspect the Alliance will emphasise in the report is the underused potential of Community Diagnostic Centres. In its initial guidance, NHS England recommended both standard NT-proBNP testing and point- of-care testing as a “minimum core test for a standard CDC”. However, our research shows that most of the country’s established CDCs do not offer or have not performed these tests. Given that patients who use Community Diagnostic Centres tend to be older and have other underlying comorbidities that make them more susceptible for heart failure, CDCs
represent an important part of a broader strategy for the early diagnosis of the condition. Following the research, the Royal Society of Pathologists supported the use of these tests in CDCs and the British Society for Echocardiography also called for wider adoption, as a means to effectively triage referrals, while reducing unnecessary referrals. Alongside this, the Alliance’s report examines the use of a case-finding service in community pharmacies, integrated with the existing hypertension service. The Alliance is planning to trial this service in an area with high prevalence, aiming to utilise additional screening questions to identify high-risk patients for an NT-proBNP test. Pumping Marvellous has already achieved success with pop-up screening clinics using point-of-care tests that can deliver an NT- proBNP result in around ten minutes. Expanding community diagnostic capacity for heart failure has also been supported by several innovative population health measures undertaken by Integrated Care Boards across the country. In Leicestershire, appointed heart failure champions have taken on a proactive role in working with CVD Prevent leads in ICBs and primary care teams to identify patients at risk of heart failure in registers, while upskilling the workforce and raising awareness of NT-proBNP testing. There is also the potential to go further with
advances in population health data. A project in inner-city Bristol successfully identified over 100 high-risk patients, with these individuals receiving tailored care plans, medications reviews and lifestyle support to both reduce the risk of presenting at Accident and Emergency departments and improve their quality of life. The Pumping Marvellous Foundation has
72
www.clinicalservicesjournal.com I September 2025
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80
