As the coronavirus pandemic continues to strain healthcare services in the UK, findings from the first patient survey into the impact of COVID-19 on heart failure care have examined the wider picture in more detail.
Research by UK patient-led charity, The Pumping Marvellous Foundation, looked at the effect of the coronavirus pandemic on services and support for the 920,000 people living with heart failure in the UK. The study found that 65% of respondents reported disruption to heart failure appointments, 32% of patients reported disruption to medication and prescription services and 25% said they would only attend hospital if there was no alternative[iv].
Shortly after the results of the study were published, the National Institute for Health and Care Excellence (NICE) issued Technology Appraisal Guidance (TAG) recommending Forxiga (dapagliflozin) as the first SGLT2 inhibitor for the treatment of adult patients with symptomatic chronic heart failure with reduced ejection fraction (HFrEF), as an add-on to optimised standard care.
Here, Matt Bunyan, Director Cardiovascular, Renal and Metabolic Unit, AstraZeneca UK talks exclusively to Pharmafield about the lessons that can be learnt from COVID-19 and what the wider picture of heart failure care looks like going forward.
What does the recent NICE recommendation mean for patients living with heart failure with reduced ejection fraction?
This recommendation is exciting news for them – providing an additional treatment option that has not only been shown to reduce risk of cardiovascular death and heart failure-related hospitalisation in a relatively short timeframe (early efficacy was observed within 28 days of treatment), but also has the potential to impact their quality of life by improving symptoms[i][ii] This additional treatment option has the potential to change the current treatment landscape for people living with heart failure in England, Wales and NI.
What does the decision mean for Health Care Professionals (HCPs)?
The recent NICE decision not only provides HCPs with an additional treatment option for symptomatic patients with heart failure and reduced ejection fraction on top of standard of care, but also recommends that dapagliflozin can now be prescribed by GPs on the advice of a heart failure specialist. This means patients now have access to this treatment through both primary care settings on the advice of a specialist and in hospitals[iii].
This is of particular importance at a time when the NHS is under immense pressure and there is a need to minimise contact with HCPs and reduce the risk of patients needing to be hospitalised as a result of their condition. It is critical the incidence of unplanned admissions is reduced, not just during a pandemic but in the long-term as well, to help alleviate the burden of heart failure on people living with the condition and the NHS.
How has COVID-19 impacted heart failure care?
Dramatically. The Alliance for Heart Failure, which is a coalition of different patient groups, healthcare companies and other organisations working together to grow awareness of heart failure, just released a report warning of a significant post-COVID-19 spike in heart failure, due to an estimated two-thirds of patients not presenting at health facilities amid fears of contracting the virus[iv].
While there will clearly be a need to review care throughout and following the pandemic, it is important to note there have been some positive changes too. In working to overcome the unique treatment challenges presented by COVID-19, we have improved the lines of virtual communication between specialists and people living with heart failure. I hope that this is something that continues post-COVID as it has the potential to markedly improve the quality of care that can be offered in primary care, with patients more likely to be able to readily access a heart failure specialist[vi].
Treatment options that minimise contact with HCPs obviously have their benefits during a pandemic, but how can we bridge the gap so that patients feel looked after at home?
Minimising contact with healthcare professionals should be done in a way that benefits the patient, and I believe it is incumbent on the pharmaceutical sector to help provide high quality online and offline resources, so people can have access to the right information wherever they are. Collaboration with NHS partners to ensure support is freely available to help both people living with heart failure and their loved ones is something which has only become more crucial during the pandemic.
How can pharma work collaboratively with the NHS to reduce the impact of heart failure?
The NHS faces a range of pressures, so it is essential we do everything we can to help. We are proactively looking to partner with various primary care networks across the country to help reduce the burden of heart failure, and we are continually looking at how we can utilise new technologies to help improve the treatment and management of heart failure in the UK. For example, we are currently involved in a number of local pilot programmes to support improved patient outcomes, from remote monitoring and patient pathway redesign, to programmes that can help reduce the need for patients to visit hospitals for diagnostic procedures, such as echocardiograms.
What lessons can be learned from COVID-19 and applied to the treatment of heart failure?
There are two key lessons from my perspective:
- We have gained a broader understanding of how digital technologies can be leveraged to help us better treat and manage people living with heart failure
From a digital point of view, I think we have caught up by five or ten years in terms of how the NHS operates alongside the pharmaceutical industry and, in making use of these digital platforms, we have been able to expand our offering, hosting many more meetings to facilitate ongoing medical education activities with a greater number of healthcare professionals.
- We have seen the lines of communication between general practice and secondary care become more digitally-focused
This could help streamline conversations across multi-disciplinary teams, or reduce the need for patients to travel to multiple appointments in different locations, and may speed-up improved management pathways for people living with heart failure in the coming months and years.
At the end of the day, that’s what we’re all working towards, and despite the huge challenges that COVID-19 has thrown up, it has also highlighted where we need to continue to improve and evolve to deliver better outcomes for people living with heart failure in the UK.
[i] McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;381:1995-2008.
[ii] Sabatine MS, DeMets DL, Inzucchi SE, et al. Timing of onset of clinical benefit with dapagliflozin in patients with heart failure: an analysis at DAPA-HF. Poster presented at: American Heart Association Scientific Sessions; November 16-18, 2019; Philadelphia, PA.
[iii] National Institute for Health and Care Excellence. Final Appraisal Document. Dapagliflozin for treating symptomatic chronic heart failure with reduced ejection fraction. Issue date: December 2020.
[iv] Pumping Marvellous. Impact of COVID-19 and heart failure care in the UK. Available at: https://pumpingmarvellous.org/impact-of-covid-19-and-heart-failure-care-in-the-uk/ Last accessed February 2021.
[v] Alliance for Heart Failure. Heart failure: a call to action – A review of the 2016 ‘Focus on Heart Failure’ recommendations to improve care and transform lives. Available at: https://allianceforheartfailure.org/wp-content/uploads/2021/02/AHF-HF-A-Call-to-Action-FINAL.pdf Last accessed February 2021.
[vi] Almufleh A, Givertz MM. Virtual health during a pandemic: redesigning care to protect our most vulnerable patients. Circulation: Heart Failure. 2020;13:193-195.