1.1 Heart Valve Voice (HVV) is the UK’s dedicated heart valve disease charity. We work with patients and clinicians to help increase the awareness of heart valve disease in the UK and improve diagnosis and treatment. Heart valve disease affects over 1.5 million people over the age of 65 in the UK and while there have been many advancements in the treatment of this disease the unfortunate fact is that far too many people are not being diagnosed and treated early enough. Since our formation in 2014, our aim has been to ensure that more of the population is aware of the importance of having their heart checked for heart valve disease, which can often be detected through a simple stethoscope check.
1.2 We welcome the opportunity to submit evidence to this important inquiry and hope that, in the wake of a global pandemic, this submission can help many more heart valve disease (HVD) patients getting the timely treatment they need to go on to live full and happy lives.
1.3 As the COVID-19 pandemic subsides, the backlog of heart valve disease patients should be treated as an issue of urgency. Early intervention returns older patients to a good quality of life in optimal time.
2.1. We know that the COVID-19 pandemic affected the care of patients nationwide, but also that the NHS made great strides to pivot its practices and continue to facilitate optimum outcomes for patients.
2.2. Nonetheless, at the very height of the COVID-19 outbreak, HVV surveyed[i] UK cardiac clinicians to understand how they had responded to the pressures placed on them by the pandemic. The survey revealed that in many centres, anything other than very urgent cases had been put on hold, while staff were deployed to other areas. Therefore, two thirds of respondents reported increased waiting times for an echo, while nine out of ten responding clinicians saw a reduction in the number of echocardiograms conducted per month. This is consistent with the findings of a report from the Institute for Public Policy Research (IPPR), which found that the total number of echocardiograms undertaken in 2020 decreased by 44% compared to 2019[ii].
2.3 Treatment for HVD was also affected, with more than 2/3 of responding clinicians having recommended a patient delays treatment until after the pandemic and only 31% reported to have continued to treat patients in line with standard practices.[iii] Out of the clinicians that Heart Valve Voice surveyed, all observed a drop in the amount of heart surgeries taking place throughout the pandemic, with some noting a decrease of more than 40%.[iv]
2.4 In addition, 73% of cardiac clinicians saw a reduction in primary care referrals for HVD.[v] Of those asked, 93% of clinicians attributed this to patients not presenting due to fear of COVID-19. Again, this is concerning, as for patients with heart valve disease, early diagnosis and treatment is vital. The lack of presentations to primary care and the consequent lack of secondary referrals indicated bigger issues being stored up, potentially leading to worse patient outcomes and future additional cost and resource impacts on an already stretched NHS.
2.5 As a result, a group of untreated HVD patients joined together in a statement urging healthcare providers to retain treatment capacity during the second-wave of COVID-19. They highlighted that according to Hospital Episode Data[vi], aortic valve replacements (AVR), the most common form of valve disease treatment, fell by 29% vs LY (April - September 2020). This equated to 1,635 lost treatments, creating an ever-increasing backlog of patients in the system. HVV estimated that if the second wave of COVID-19 had a similar impact, the NHS could lose as many as 1,162 AVR treatments from October 20 to March 21, taking the total lost treatments in 12 months to 2,817.
2.6 HVV therefore published a Three Point Plan to limit the impact of the second wave of COVID-19 on HVD patients: urging patients to go to the doctor; primary care clinicians to refer in a timely way; and secondary care providers to reassess treatment options to maximise treatment capacity[vii].
2.7 Sadly, the latest findings published by the British Heart Foundation (BHF) in July 2021 revealed that 242,181 people were waiting for invasive heart procedures, including heart surgery at the end of May – the highest number for May on record. Of those waiting, 52,484 had been waiting over 18 weeks – this is more than one in five (22 per cent) of all patients waiting for a heart surgery or another invasive procedure at the end of May 2021[viii]. This represents an unprecedented backlog in the care of CVD patients.
3.4 We believe that there needs to be greater investment in echocardiography training to ensure that the workforce is expanded and that patients are able to access this service quickly in light of the backlog. It should be noted that a 2016 report by the APPG on Heart Disease, outlined that there was an acute shortage of echocardiographers in the UK – with only 44 individuals trained that year, and severe delays for many patients waiting for an echocardiogram[ix].
4.1 As part of the NHS Long Term Plan, NHS England has sought to introduce community diagnostic hubs to act as “one stop shops”. These hubs could provide an ideal location to undertake transthoracic echocardiograms so that once a patient with a heart murmur is detected, the necessary steps can be taken to identify HVD as quickly as possible. Throughout the COVID-19 pandemic, the portability of echocardiography machines has meant that patients have been able to attend a community centre for a full echo study, just as they would have in hospital departments. It is therefore our hope and recommendation that the expansion of these community diagnostic hubs continues in the post-pandemic era, so that patients can receive timely diagnosis, diagnosis backlogs caused by the pandemic can be reduced, and much needed hospital capacity is freed-up.
4.2 Handheld echocardiography devices, and digital stethoscopes in particular, can help to improve the accuracy of diagnoses in those with heart murmurs. In addition, due to their ease of use, such devices are can be used by a greater number of healthcare professionals (such as pharmacists or nurses), to ease the burden on GPs following COVID and aid detection in non-traditional settings.
4.3 NHS England should develop a national breathlessness awareness campaign to ensure that the population is aware of the link between this key symptom and heart disease, including HVD, and recognise the need to visit their GP should they experience it. We are concerned that a high volume of individuals has failed to present in primary care owing to COVID-19 and therefore have not received a diagnosis, and the treatment that they need.
5.1 NHS England should encourage the longer-term adoption of novel ways of working implemented during the pandemic, such as telemedicine, as the NHS seeks to recover. However, it is important to continue face-to-face appointments for diagnosis and treatment where appropriate.
5.2 The NHS should continue collaborating with the private sector to bolster the COVID-19 recovery. King’s College Hospital, through private sector and NHS partnership was able to add some capacity to treat heart valve disease patients during the busiest phases of the pandemic for the NHS, ensuring that the most vulnerable were treated while taking every COVID-19 precaution to keep them safe.[x]
[ii] Institute for Public Policy Research. 2021. Without Skipping a Beat: The case for cardiovascular care after Coronavirus. Available at: https://www.ippr.org/files/2021-03/without-skipping-a-beat.pdf
[iii] Heart Valve Voice Impact of COVID-19 on HVD Survey (2020), https://heartvalvevoice.com/application/files/8616/0309/3280/246_-_Impact_of_COVID-19_on_HVD_v1_181020.pdf
[iv] Heart Valve Voice Impact of COVID-19 on HVD Survey (2020), https://heartvalvevoice.com/application/files/8616/0309/3280/246_-_Impact_of_COVID-19_on_HVD_v1_181020.pdf
[v] Heart Valve Voice Impact of COVID-19 on HVD Survey (2020), https://heartvalvevoice.com/application/files/8616/0309/3280/246_-_Impact_of_COVID-19_on_HVD_v1_181020.pdf
[vi] Hospital Episode Statistics available at https://digital.nhs.uk/data-and-information/publications/statistical/hospital-episodestatistics-for-admitted-patient-care-outpatient-and-accident-and-emergency-data/april-2020--- september-2020
[vii] Heart Valve Voice, A Message To the Valve Disease Community available at https://heartvalvevoice.com/news/ news/message-heart-valve-disease-community-covid-19
[x] Heart Valve Voice, King’s Hospital COVID-19 TAVI Stories, available at: https://heartvalvevoice.com/news/news/kings-college-hospital-covid-19-tavi-stories