Nearly 80% of heart failure cases are diagnosed in hospital only after emergency admission, even though 40% of patients exhibit symptoms that should prompt earlier assessment.
Differentiating between respiratory and cardiac causes can be challenging, with up to 20% of hospital admissions for COPD exacerbation later identified as left ventricular failure. With an aging and growing population, cases are expected to rise and in response the NHS Long Term Plan has pledged action to promote earlier diagnosis.
By expanding access to echocardiography in primary care settings, healthcare providers can more effectively investigate breathlessness, enabling earlier detection and treatment of heart failure and valve disease.
NSHI have developed a service in line with the NHS long-term plan, which supports practices to provide a cardiac work-up for breathless patients, where the patients do not have COPD or where the patient’s breathlessness is disproportionate to their lung function i.e., the patient may have an additional co-morbidity.
As people age, they are more likely to have more than one chronic long-term condition.
- 4.5% of all people aged over 40, lives with diagnosed COPD.
- 80% of people with COPD have at least one other long-term condition.
The aim of the service is to improve the screening and care pathways, for the following cohorts of patients who present with symptoms of breathlessness whilst undertaking a COPD clinic within your practice.
Patient Cohort 1: Patients who may have suspected COPD diagnosis but have non obstructive spirometry.
- For these patients the NSHI Specialist Nurse Advisor reviews MRC scores and signposts patients with significant breathlessness, i.e. MRC ≥ 3, to be put forward for a full cardiorespiratory examination, FBC, ECG & BNP to ascertain the correct cause of breathlessness.
- The key to the diagnosis of structural heart disease is the BNP level and echocardiogram.
Patient Cohort 2: Patients with confirmed COPD whose breathlessness is found to be disproportionate to their lung function and may have an additional cause of breathlessness.
- NSHI Specialist Nurse Advisor arranges a 12 lead ECG and venous blood tests which include FBC and BNP.
- The patient will undertake a full cardio-respiratory examination at their next clinic appointment.
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