Poor NHS care putting the lives of tens of thousands of women at risk

Poor NHS care is putting the lives of tens of thousands of women with heart failure at risk, Oxford University study finds

  • Female patients receive ‘suboptimal care’ when it comes to heart failure
  • Includes poor diagnosis, inadequate prescriptions and insufficient follow-up
  • Women are 13% less likely than a man of the same age to get life-saving drugs 

Poor NHS care is putting the lives of tens of thousands of women with heart failure at risk, research suggests.

A study by Oxford University found female patients receive ‘sub optimal care’ when it comes to diagnostic tests, prescriptions and follow-up appointments. 

They are even 13 per cent less likely than men of the same age to receive life-saving drugs, the research found.  

Poor NHS care is putting the lives of thousands of women with heart failure at risk (stock)

The research was led by Dr Nathalie Conrad, a PhD student who focuses on the epidemiology of cardiovascular diseases.

‘Heart failure is a severe condition and early diagnosis is crucial for doctors to rapidly initiate life-saving medications,’ Dr Conrad said.

‘Our findings suggest out-of-hospital screening for early signs of heart failure and follow-up are sub-optimal.

‘And women and older patients are particularly vulnerable to these shortcomings in current heart failure care.’

Heart failure affects more than 900,000 Britons, which makes it more common than the four most prevalent types of cancer in the UK combined, the researchers wrote in the journal PLOS Medicine. 

Sudden worsening of symptoms, namely breathlessness, fatigue and swollen ankles, make ups around five per cent of all unscheduled hospitalisations. 

Although heart failure’s treatment is well understood, the researchers had reason to believe ‘significant gaps exist between guideline-directed practice and clinical practice’. 

To get to the bottom of this, they analysed 93,000 anonymous health records from the Clinical Practice Research Datalink, which collects patient data from a network of GP practices across the UK. 


Heart failure means that the heart is unable to pump blood around the body properly. It usually occurs because the heart has become too weak or stiff. 

Heart failure doesn’t mean your heart has stopped working – it just needs some support to help it work better. It can occur at any age, but is most common in older people.

Heart failure is a long-term condition that tends to get gradually worse over time. It can’t usually be cured, but the symptoms can often be controlled for many years.

The main symptoms of heart failure are:

  • breathlessness after activity or at rest
  • feeling tired most of the time and finding exercise exhausting
  • swollen ankles and legs

Some people also experience other symptoms, such as a persistent cough, a fast heart rate, and dizziness.

Symptoms can develop quickly (acute heart failure) or gradually over weeks or months (chronic heart failure).

See your GP if you experience persistent or gradually worsening symptoms of heart failure.

Source: NHS 

‘Over the past 25 years, the UK has introduced several programmes to evaluate and improve the quality of care received by heart failure patients,’ Dr Conrad said.

‘However, little was known about patients’ journey of care across primary and secondary care services.

‘This is a critical component of chronic disease management, so we set about addressing these knowledge gaps in order to provide evidence-based recommendations to strengthen health systems.’

This is the first time patients, who were diagnosed with heart failure between 2002 and 2014, have been looked at across different NHS settings, such as hospitals and GP surgeries. 

In 2002, more than half (56 per cent) of heart failure diagnoses were first recorded in a hospital rather than during a doctors’ appointment. 

This dropped to just 36 per cent in 2014. 

After they were discharged, the patients were followed for at least a year.

The researchers deemed the level of care the patients received inadequate, particularly for females and people over 75.  

This included doses of key medicines being prescribed far below those recommended by clinical management guidelines. 

Women were found to be 13 per cent less likely than men their age to receive a prescription for the two most important drugs – ACE1 inhibitors and beta-blockers – within three months of being diagnosed.

They were also nine per cent less likely to be diagnosed in a GP surgery.

Jacob West, director of healthcare innovation at the British Heart Foundation, said: ‘Nobody with heart failure should experience inferior care because of their age or gender – but this study highlights widespread inequality in care experienced by older people and women.’

Gender aside, the results further revealed just one in six (17 per cent) of the patients who were diagnosed in hospital had their condition recorded on their GP records the next year. 

Poor record-keeping along with the inadequate exchange of information between hospitals and GPs may be to blame, according to the researchers. 

‘Health systems need to recognise the patient journey as a care continuum to improve care quality, adhere to treatment guidelines and provide more equitable access for all those at risk of, or living with, heart failure,’ Dr Conrad said.

‘Particular attention needs to be given to women and older patients to ensure they receive the treatment they need within the recommended time frame.’   

Cardiologist Professor Nicholas Mills, of the University of Edinburgh, who reviewed the study for the journal, said the results underline the need for healthcare data to be collected across both primary and secondary care.

He also called for changes in clinical practice and policy to ‘overcome these disparities and gaps.’

Professor Helen Stokes-Lampard, chairwoman of the Royal College of GPs, added: ‘GPs understand the importance early diagnosis and are highly-trained to look out for the symptoms of heart disease.

‘But it is notoriously difficult to diagnose in primary care as its early symptoms are often vague and can mimic more common conditions.

 ‘GPs need better access to diagnostic tests, so that when we do suspect heart disease, we can swiftly diagnose it, but as this study shows, these are hard to come by in the community and access can be patchy across the country.

‘Access to appropriate tests would not only ensure more people with heart failure get the treatment they need, but also that patients who don’t have it are spared unnecessary trips to hospital, and instead monitored where they’d prefer – at home, in the community.’ 

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