Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

A study by Dr Nathalie Conrad and Prof Kazaem Rahimi at the George Institute (Nuffield Department of Women's and Reproductive Health) finds that women and older people are most likely to be exposed to shortcomings in heart failure care.

A study by Dr Nathalie Conrad and Prof Kazem Rahimi at the George Institute (Nuffield Department of Women's and Reproductive Health) finds that women and older people are most likely to be exposed to shortcomings in heart failure care.  Some 93,000 UK adults with heart failure took part and the research has revealed critical care shortcomings in diagnostic tests, drug prescriptions, and follow-up patterns, with women and those over 75 years of age disproportionately affected. © Shutterstock

A study of 93,000 UK adults with heart failure has revealed critical care shortcomings in diagnostic tests, drug prescriptions, and follow-up patterns, with women and those over 75 years of age disproportionately affected.

The George Institute for Global Health at the Nuffield Department of Women's and Reproductive Health (University of Oxford) investigated the medical care received by heart failure patients from the time of diagnosis up to a year later, examining variations over time based on patient characteristics such as age, sex, and socioeconomic status, as well as across outpatient and inpatient settings.

“Over the past 25 years, the UK has introduced several programmes to evaluate and improve the quality of care received by heart failure patients. However, little was known about patients’ journey of care across primary and secondary care services. This is a critical component of chronic disease management, so we set about addressing these knowledge gaps in order to provide evidence-based recommendations to strengthen health systems,” said Dr Nathalie Conrad who led the research using participants in the Clinical Practice Research Datalink.

The research team found that, overall, patients were more likely to be diagnosed with heart failure in hospital rather than by their general practitioner; received insufficient follow-up after hospitalisation; and doses of key medicines prescribed to patients were far below those recommended by clinical management guidelines, even a year after diagnosis. Critically, only 17% of patients diagnosed with heart failure in hospital had their diagnosis recorded by their general practitioner in the following 12 months.

Women and older patients were particularly disadvantaged across all these care dimensions. In particular, women were 13% less likely than men of the same age to receive a prescription for the two most important drugs in heart failure management within three months of diagnosis. Women were also 9% less likely than men of the same age and socioeconomic status to be first diagnosed with heart failure in a general practice.

“Heart failure is a severe condition and early diagnosis is crucial for doctors to rapidly initiate life-saving medications. Our findings suggest out-of-hospital screening for early signs of heart failure and follow-up are sub-optimal, and women and older patients are particularly vulnerable to these shortcomings in current heart failure care,” said Conrad.

“Health systems need to adopt a broader perspective of service design and recognise the patient journey as a care continuum to improve care quality, adhere to recommended treatment guidelines and provide more equitable access for all those at risk of, or living with, heart failure. Particular attention needs to be given to women and older patients to ensure they receive the treatment they need within the recommended timeframe,” added Conrad.

Heart failure affects about 2% of the population in high-income countries, with mortality rates comparable to the most severe cancers. Effective treatments exist but involve a complex process of investigation and step-wise initiation of medication and adjustment - care programmes that are often challenging to implement consistently.

The study was funded by the British Heart Foundation, the Oxford Martin School at the University of Oxford, and by the NIHR Oxford Biomedical Research Centre.

The paper is published in PLOS Medicine: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002805

Similar stories

Skin colour and neurodevelopment are not linked

Global Health

The latest findings from the international INTERGROWTH-21st Project, that has monitored healthy, urban children from educated families across four continents from early pregnancy to 2 years of age, show that human neurodevelopment is not influenced by the colour of an individual’s skin.

High blood pressure linked to common heart valve disorder

Global Health

For the first time, a strong link has been established between high blood pressure and the most common heart valve disorder in high-income countries, by new research from The George Institute for Global Health.

Initiative to collect women's health data in Northern Cyprus supported by multiple donations

Global Health

A project set up to provide the first systematically collected population health data for women in Northern Cyprus has received a number of generous donations. This support will enable researchers to better understand health and illness patterns, as well as the personal, social and economic burden of disease, in this relatively isolated region.

Women with heart disease less likely to reach treatment targets than men

Global Health

Women with coronary heart disease are less likely to achieve treatment targets than men, finds a study published by the journal Heart. The authors, including Dr Sanne Peters, from The George Institute for Global Health UK, say a better understanding of sex disparities is needed to treat women with coronary heart disease more efficiently in all regions, especially in Asia and the Middle East.

Honour for George Institute UK Executive Director

General Global Health Maternal & Fetal Health

Executive Director of The George Institute, UK, Professor Terry Dwyer has been awarded an honorary doctorate by Trinity College Dublin for his extensive work in child health.