Health Service Focus

Echocardiography: Awareness, accessibility and acceleration

Keith Pearce, President of the British Society of Echocardiography (BSE), discusses improving access to echocardiography in primary care for structural heart diseases.

The UK’s population is ageing. Statistics by the Office for National Statistics project in 50 years’ time there will be an additional 8.6 million people aged 65+ years, bringing new challenges to our health and social care systems.

Meanwhile, based on predictive models of the UK population, and estimates of the prevalence of heart diseases, by 2040 the UK will have 2.5 million people over 65 years old with structural heart diseases (SHDs).

What are structural heart diseases?

SHDs encompass a wide spectrum of cardiac defects which include conditions such as such as cardiomyopathies, myocardial infarction (heart attacks) which can result in structural complications, congenital anomalies and valvular heart disease. 

It is well known that the chances of developing valvular heart disease increase with age and such a disease is progressive and potentially life-threatening once symptoms appear if left untreated.

Patients who don’t receive appropriate treatment for their valve disease have a worse outcome and can experience worsening symptoms which eventually could lead to death. In some cases, the disease can progress slowly with unspecific symptoms such as a shortness of breath and/or tiredness, and these symptoms are often ignored with patients believing it a normal part of ‘getting older’. It is not unusual to identify these conditions as a coincidental finding following an assessment for other ailments.

Key areas for action for early detection in primary care

Currently, the NHS Health Check across England, and similar programmes across the devolved nations, help to recognise the first indication of any heart conditions. However, 78% of people over the age of 60 reported their doctor rarely or never checked their heart with a stethoscope during their visits.

Early detection is key, and access to high quality timely diagnosis delivered by an appropriately qualified healthcare professional is also critical. In line with the NHS Long Term Plan, improving access to echocardiography in primary care could enhance the early detection of SHDs including heart valve disease and heart failure.

Early access to diagnostic echocardiography should be available for all symptomatic patients across the UK to allow for the most effective patient management and improve outcomes.

Learning from best practices

Following the NHS Five Year Forward View, many hospitals began implementing integrated services by developing new models of care which utilise the most recent technology and innovations to support their patients.

A hospital in Manchester, for example, has taken steps to ensure patients who develop symptoms are seen quickly and assessed at record speed. Currently, the hospital is using telemedicine solutions to identify patients with SHD symptoms and within 7-14 days referring them into to a specialised clinic.

Initial findings indicate this approach has in the best case reduced the waiting time from diagnosis to surgical intervention by as much as 50%.

Other initiatives such as the national screening programme for aortic abdominal aneurysm have helped raise awareness and may help us understand the potential value and challenges to population screening.

BSE calls on raising awareness of SHD

There are treatments available for SHDs across all patient age groups which add healthy years to people’s lives and therefore improve outcomes and the quality of life. While the challenges in providing services are significant, it should not be put into the “too difficult box” given there are real opportunities to have a significant impact and make a difference to patients suffering from SHDs.

The British Society of Echocardiography recognises the importance of early detection and treatment of SHDs and has outlined three key areas for action:

• AWARENESS: There needs to be greater awareness of SHDs not just among the healthcare professionals and policymakers, but directly among patients and the general public.
• ACCESSIBILITY: It is critical patients have access not only to early detection in the form of a stethoscope check, but also high-quality timely diagnostics such as echocardiography delivered by an appropriately qualified healthcare professional.
• ACCELERATION OF TREATMENT: Once diagnosed, finding solutions to accelerate the process for intervention will not only reduce hospital admissions but could also prevent the premature death of patients, reduced hospitalisation and improve the quality of life for patients.