New report analyses first of its kind survey of heart failure patients in Ireland

Female patients in Ireland are waiting almost twice as long as men to be diagnosed with heart failure, with delays to diagnosis associated with poorer quality of life, mental health issues, and impact on relationships, a new report has revealed.

The report launched today (Wednesday 27th April 2022), State of the Heart: Heart Failure in Ireland, by Roche Diagnostics and the Irish Heart Foundation, sheds light on the stark realities of receiving a diagnosis of heart failure in Ireland and highlights the need for early and accurate diagnosis to ensure patients receive rapid access to the care they need.

The report analyses data from a first of its kind survey of heart failure patients in Ireland, conducted by Censuswide, which reveals the staggering reality of some patients’ experiences of diagnosis, the difficulties of living with heart failure during the Covid-19 pandemic, and the need to better educate the public on the symptoms of the condition.

The report also identifies a significant gender disparity between the experiences of male and female patients, with female patients waiting longer to be diagnosed with heart failure than men. On average, women have to wait five weeks to receive a formal diagnosis of heart failure, compared to men who have to wait three weeks. Women are also more likely to delay seeking help from health professionals after first developing symptoms, with females making appointments at four weeks – almost twice as long as males.

Heart failure experts often warn that a key challenge in diagnosing heart failure is that many people are not aware of the symptoms. Only seven per cent of the Irish population can correctly identify three symptoms of heart failure. Furthermore, common heart failure symptoms, such as fatigue, shortness of breath, and swollen ankles and legs, are not unique to the condition, making it difficult for patients and healthcare professionals to recognise the early signs of heart failure.

The report also exposes the personal toll of a late heart failure diagnosis with 72 per cent of patients saying that their lives would have been better if they had received their diagnosis earlier. It further revealed that a delayed diagnosis can have negative emotional, social, and financial impacts, finding that:

• Mental health is the most identified negative impact of a delayed diagnosis, with 70 per cent of respondents saying their emotional wellbeing or mental health was affected. Females (73%) also experienced a greater mental health impact than males (69%).
• More than half (58%) said their delayed diagnosis had impacted their ability to work, resulting in financial losses.
• A delayed diagnosis also influences patients’ personal relationships and their family life. The report found this is more common for women, with 39 per cent  feeling their relationship with their partner was negatively impacted compared with a quarter (25%) of men.
• While waiting to receive a final diagnosis for heart failure, over a third (37%) of patients said they did not understand their prognosis. This was more typical for women, with 43 per cent noting they did not understand their prognosis compared with 35 per cent of males.

The report recommends that there should be increased signposting for patients to information so they can better understand the impact of their condition, and increased education for the public on the symptoms of heart failure to support earlier detection of the condition.

Pauline O’Shea, who was 38 when she was diagnosed with heart failure said, “Women and sometimes young women can get heart failure too. Viruses, genetics, and hormones can play a big part. There is still a lack of public knowledge around the term ‘heart failure’, which is also impacting the ability to spot common symptoms such as breathlessness and fatigue. Learn the signs and if you start to experience even some of these, go to your doctor and ask for a BNP test. It could save your life.”

The route to heart failure diagnosis is often long and complicated and receiving a diagnosis in Ireland can be a difficult journey for patients. Heart failure is notoriously difficult to diagnose and healthcare professionals need access to the right tools to make an accurate diagnosis.

BNP and NT-proBNP are measured via a blood test to help diagnose and monitor heart failure.

Measuring natriuretic peptide levels provides healthcare professionals with the information they need to identify a potential case of heart failure, or rapidly rule it out. However, until recently, GPs in Ireland did not have access to these tests, such as NT-proBNP, and this contributed to patients experiencing delays in being referred for echocardiography and specialist assessment.

While there has been a recent push for GPs to have access to these tests, the report calls for the planned access to NT-proBNP in primary care to be accelerated and applied consistently across Ireland, to ensure potential cases of heart failure are identified at the earliest opportunity.

Dr Angie Brown, Consultant Cardiologist and Medical Director of the Irish Heart Foundation, said: “This report confirms the negative impact that a diagnosis of heart failure can have on a person’s life. It highlights the need to increase the awareness of the signs and symptoms of heart failure, particularly in women, and demonstrates that we must do more to facilitate a prompt diagnosis and help patients live as well as possible with their condition.

“We need policymakers to understand that service improvements focusing on the health and wellbeing of people living with heart failure can be highly cost-effective, particularly against the backdrop of unacceptably high readmission rates amongst those affected. Community-based services should be an integral part of a heart failure pathway that extends beyond hospital care to meet patient needs at every stage of their journey after diagnosis.

“The National Cardiac Services Review promises to go some way to addressing these issues, but we need an overarching and fully funded National Cardiovascular Policy and Strategy to ensure optimal treatment and care of people across the full spectrum of heart conditions,” Dr Brown added.

Prof Ken McDonald, Clinical Professor at UCD and Consultant Cardiologist at St Vincent’s Healthcare Group. Clinical Lead of the HSE National Heart Programme, said, “A delayed diagnosis of heart failure has a significant impact on people’s lives and, in many cases, causes avoidable health deterioration and mental distress. Heart failure merits the earliest possible diagnosis and treatment and a prolonged delay in diagnosis worsens outlook.

“It is, therefore, crucial that we continue to drive forward the solutions being introduced by HSE, including ensuring that GPs have access to the right testing to improve diagnosis and management. I am hopeful that the outlook for patients is improving – we must work together to ensure this becomes the reality for patients.”

Finbarr Kenny, Director of Ireland and  European Agencies Countries at Roche, said, “This report highlights the stark realities that patients with heart failure continue to face. As a community, we urgently need to work together to rectify the inequalities and ensure that all patients are receiving timely diagnosis and treatment, no matter what age or gender. The education of signs and symptoms, as well as access to the right testing, has the potential to save lives. Which is why we need to work together to ensure healthcare professionals have access to and are using, the diagnostic tools which are already available.”

The Irish Heart Foundation provides a wide range of information and support for people living with heart failure please see here.