Reducing heart failure hospitalisations starts by learning from COVID-19

Heart failure poses a significant challenge in Europe, affecting nearly 15 million people in the region.¹ As we move into 2021, it’s important that we take learnings from the COVID-19 crisis on board, including the relatively simple measures we can take to avoid hospitalisations and death. The Heart failure policy and practice report – developed by the Heart Failure Policy Network – looks at the way forward for heart failure care.² Here are my key takeaways.

A problem on the rise

Heart failure is a major cause of hospitalisations – resulting in almost two million admissions a year in Europe.³ With an ageing population and risk factors for heart failure (including cardiovascular disease, diabetes and obesity) also on the rise, the burden is only projected to grow.² By current projections, hospital admissions for heart failure are expected to rise by 50% in the next 25 years in the UK.^{4, 5}  If we don’t start to make meaningful improvements, we risk the sustainability of our healthcare systems.²

The COVID-19 crisis has highlighted a new level of vulnerability for people living with heart failure and the current shortcomings in health services.⁶ Hospital admissions have actually fallen since the start of the pandemic – down 66% in the UK compared to the previous year.⁷ This is worrying, as it could result in a backlog of missed or delayed diagnosis and deterioration of those needing treatment.

The need for political recognition

Thankfully, we already know what to do. Best-practice care models, focused on integrated and multidisciplinary care, have the potential to reduce heart failure hospitalisations and costs by up to 30%.² Now, it’s just a matter of putting them into practice. We have seen some great initiatives and pilot programmes taking place at a local or regional level, but without political backing, these programmes aren’t being scaled up.²

This challenge is increasingly being recognised by the Spanish Government, as demonstrated by the inclusion of heart failure in its forthcoming national strategy on cardiovascular health.² This is great progress, but unfortunately not the current standard in Europe. Most countries lack a dedicated strategy on tackling the disease, or when formal plans do exist, they are often out of date, lack funding or may have stalled.² If we really want to change the course of heart failure in Europe, it needs political recognition, with strategies that provide a comprehensive blueprint for change.

We also need a level of accountability, with clear benchmarks and reporting. National registries to assess care and outcomes for people with heart failure are not standard practice.² Without them, poor performance goes unchallenged and it becomes difficult to determine if countries are on track to meet targets.

Acting now to reduce preventable hospitalisations

So how do we move forward? We know we need long-term strategies to transform heart failure care, but there are also things we need – and should be – getting right as we move into 2021.

1. Timely diagnosis: Early diagnosis means early intervention, and ultimately better outcomes for patients.² For this to occur, testing needs to be universally reimbursed and incentivised across all care settings.² New technologies can also play an important role here. At AstraZeneca, we are collaborating with two digital health innovators, Eko and Us2.ai, on solutions designed to accelerate heart failure diagnosis using artificial intelligence.
2. Improved discharge: Guideline-based care is linked to better outcomes for people living with heart failure, particularly when it is supported by pathways and decision-making protocols.² High-quality hospital care and a thorough discharge plan are crucial to reducing the risk of readmission in a critical transition period.² We need to see best-practice protocols, including checklists, communication with primary care physicians, individualised guidance for ongoing care and telemedicine appointments used to supplement – not replace – in-person appointments implemented more widely.
3. Self-care education: The majority of heart failure hospital admissions are considered preventable with effective community services.^{8, 9} This requires an integrated and multidisciplinary approach to care that prioritises cardiac rehabilitation programmes, psychological support and self-care education, where people with heart failure are taught to monitor their own symptoms, effectively manage treatments, maintain a healthy lifestyle and recognise when to seek support.

Looking to the future

We know what works when it comes to improving heart failure care and now it’s time to put our efforts into action and outline tangible goals and targets. At AstraZeneca, we are committed to working in partnership with key stakeholders to elevate heart failure as a political priority, enhance prevention and our capabilities to diagnose earlier, and improve patient management. By 2024, our goal is to reduce hospitalisations for heart failure by half and improve the five-year survival rate for heart failure by 20%.

Education is another big priority. Heart failure remains as ‘malignant’ as some of the most common cancers in both men (prostate and bladder cancers) and women (breast cancer),¹⁰ yet it doesn’t see nearly the same level of awareness or action. To elevate awareness of the disease, AstraZeneca has partnered with the World Heart Federation on the Spotlight On Heart Failure campaign to educate everyone, from policymakers to healthcare professionals and the general public, about the magnitude of heart failure and how they can challenge the status quo.

We continue to see the impacts of COVID-19 on heart failure care and we need to be prepared to tackle this challenge head on in 2021 as cases continue to rise around the world if we want to avoid preventable hospitalisations and deaths. We already have the solutions and knowledge we need to make a real impact, now we just need to see them in action.

References

1. Dickstein K et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 2008; 10(10):933–89.
2. The Heart Failure Policy Network. Heart failure policy and practice in Europe; 2020 [cited 25 Nov 2020]. Available from: URL: https://www.hfpolicynetwork.org/wp-content/uploads/Heart-failure-policy-and-practice-in-Europe.pdf.
3. Organisation for Economic Cooperation and Development (OECD)/ European Union (EU). Health at a Glance: Europe 2018: State of Health in the EU Cycle. Paris: OECD Publishing. doi: 10.1787/health_glance_eur-2018-en.
4. Cowie MR et al. Improving care for patients with acute heart failure: Before, during and after hospitalization. ESC Heart Fail 2014; 1(2):110–45.
5. National Institute for Health and Care Excellence. Chronic Heart Failure (update): Prioritised quality improvement areas for development; 2015. Available from: URL: https://www.nice.org.uk/guidance/qs9/documents/chronic-heart-failure-in-adults-qs-briefing-paper2.
6. Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19): People with Certain Medical Conditions; 02 Nov 2020 [cited 24 Nov 2020]. Available from: URL: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html.
7. National Institute for Cardiovascular Outcomes Research (NICOR), National Cardiac Audit Programme (NCAP). Rapid cardiovascular data: We need it now (and in the future); 2020. Available from: URL: https://www.nicor.org.uk/covid-19-and-nicor/nicor-covid-19-report/.
8. World Health Organization Regional Office for Europe. Ambulatory care sensitive conditions in Germany – December 2015. Copenhagen. Available from: URL: https://www.euro.who.int/__data/assets/pdf_file/0004/295573/ASCS-Germany-2015-rev1.pdf?ua=1.
9. World Health Organization Regional Office for Europe. Ambulatory care sensitive conditions in Portugal – April 2016. Copenhagen. Available from: URL: https://www.euro.who.int/__data/assets/pdf_file/0007/307195/Ambulatory-care-sensitive-conditions-Portugal.pdf.
10. Mamas MA et al. Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland. Eur J Heart Fail 2017; 19(9):1095–104.