Research published by Heart Valve Voice, a UK charity, reveals that delays in heart valve disease diagnosis are disproportionately affecting those living in the most deprived areas of the country.
A survey of over 300 heart valve disease patients has shown that three-quarters of respondents in the lowest income decile said their diagnosis had been delayed (with just one in four reporting they were diagnosed without delay). Contrastingly those living in the least deprived decile were unlikely to experience delays, only one in five reported delays to diagnosis (most (64%) were diagnosed without delay).
Wil Woan, executive director at Heart Valve Voice, comments: “Many patients who took part in the survey experienced a diagnostic delay, but when we look at the most deprived areas it’s around half—47%—while for the least deprived areas it’s lower—34%. When we compare the decile of highest deprivation to the decile of lowest deprivation we see a troubling disparity: 75% of those in the most deprived decile experienced a delay vs. just 20.5% in the least deprived. The findings have prompted us to renew calls for targeted action to address inequalities in access to Valve Disease diagnosis treatment.”
“In areas of social deprivation many people don’t know anything about heart valve disease and certainly don’t know the symptoms. Moreover, they often don’t present to their GP or follow conventional treatment pathways. Valve disease symptoms often creep in slowly and it’s easy for patients to brush them off or put them down to normal ageing, sometimes until they are seriously ill and end up presenting in A&E,” says Phil MacCarthy (Kings College Hospital, London, UK).
For most patients, delayed diagnosis was due to issues arising in primary care—the most common reason cited was GPs not spotting their symptoms (14%). Symptoms not taken seriously (9%), symptoms misdiagnosed (9%) or needing to see the GP multiple times (9%) were also common challenges. In a minority of cases, it was the patient themselves not taking symptoms seriously which contributed to their delay (6%).
However secondary care also presented challenges in many cases, with delays to diagnostics (like echocardiogram) or other tests reported. When asked about the greatest impact of their delay, a quarter of patients cited worsening symptoms, while 15% pointed to the toll on their mental health. Seven per cent said it had forced them to take extended time off work. The strain on NHS resources was also evident. Around a third of patients reported that delays had led to increased use of healthcare services, with 11% requiring frequent GP appointments, 9% making repeated visits to A&E, and a further 11% needing emergency ambulance transport to A&E.
“These findings show that delays cause avoidable harm, both physical and emotional, and place unnecessary pressure on frontline services,” adds Woan. “Ultimately, these delays can lead to poorer outcomes for patients, and, in some cases, deaths. Our charity is also concerned about the delays patients are experiencing after diagnosis.”
Thirty-nine percent of patients experienced delays accessing treatment after being diagnosed, with NHS waiting lists given as the most common reason for about half of these patients (49%). Staff shortages and limited access to specialists were also highlighted.
“Our hospital serves a large catchment area, spanning much of the North West, Merseyside, Lancashire and even North Wales and the Isle of Mann—which all have areas of significant deprivation and higher rates of cardiovascular disease,” explains Clare Appleby a consultant cardiologist at Liverpool Heart and Chest Hospital (Liverpool, UK), who is the institution’s clinical lead for intervention and transcatheter aortic valve implantation (TAVI). “At our hospital we see a huge variation in the referral numbers of TAVI patients from the most deprived areas compared to the most affluent—it can be as much as five-fold difference. The causes of this disparity are varied and complex – as well as patient’s factors, it might be due to staff shortages, more vacant posts, lower access to diagnostics at the hospital, healthcare professionals that are less familiar with new guidance or referral patterns or that the hospital in one area is serving bigger populations with significant social deprivation. These disparities warrant further investigation to help guide us on how we can improve equity for patients.”
