Avoidable deficiencies in heart failure cost NHS £21m

Avoidable deficiencies in heart failure cost NHS £21m

Real-world NHS data has revealed that inadequate management of iron deficiency (ID) and iron deficiency anaemia (IDA) in heart failure patients is costing the NHS an extra £21.5m due to lengthier and costlier hospital stays.

Today, a first investigation of its kind has identified the hidden costs of heart failure within the NHS due to under-managed but treatable iron deficiency (ID) and iron deficiency anaemia (IDA).

Nearly one million people in the UK live with heart failure, of whom around 50% may also suffer from ID. Leading UK clinicians assessed the one-year data of around 80,000 people with heart failure as part of the analysis.

The investigation revealed that potentially a third of people with heart failure are not being screened for ID/IDA, with potentially debilitating effects on their quality of life.

With an NHS deficit of £960m reported for 2017/2018, hospital bed occupancy hitting an eight-year high in 2018, and a near 7% rise in emergency admissions to hospitals reported for 2018/19, correct management of these patients presents an opportunity for cost-savings for an over-stretched healthcare system.

The hidden costs of heart failure

ID is simple to identify and treat, but it is widely ignored across the board. Heart failure patients with unidentified ID can lead to avoidable cases of patients arriving as emergencies at A&E departments throughout the country and adds to existing hospital bed pressures.

This analysis has found that heart failure patients found to have ID/IDA are more likely to be re-admitted to hospital within 30 days than those without ID, 95% of whom present as emergency admissions.

Dr Rani Khatib, Consultant Pharmacist in Cardiology and Cardiovascular Research, Leeds Teaching Hospitals and co-author of the analysis published in Open Heart said: “Some evidence suggests that iron studies are conducted in less than 20% of heart failure patients admitted to NHS Trusts, which is not enough when you consider that 50% of these patients are likely to be iron deficient.

“The published data estimate an additional £21.5m a year is being spent on managing co-morbid patients with heart failure and iron deficiency or iron deficiency anaemia, and this is based on the small proportion of those who were found from testing, so the true cost is likely to be much higher. There is a clear need to raise awareness about the growing evidence in this area and translate into practice accordingly.”

Effective community care and case management of patients with IDA can help prevent the need for hospital admissions, with an estimate that emergency hospital admissions for ambulatory care sensitive conditions (ACSCs) could be reduced by up to 18%.

Relieving pressure on the NHS

This study highlights the importance that consistent management of ID/IDA, treatable co-morbidities in HF, could help relieve some of the current burden on the NHS and improve the quality of life of patients.

The study showed that in patients who were screened and treated for ID, data show that the amount of time they spent in hospital varied widely, with a difference of up to 18 bed days.

European, Scottish and American guidance highlight the importance of managing ID/IDA in heart failure patients in order to improve patients’ quality of life and exercise capacity, and reducing hospitalisations, recommending that clinicians consider available intravenous iron therapy in appropriate patients.

Dr Simon Williams, Consultant Cardiologist, Wythenshawe Hospital, Manchester and fellow co-author of the analysis published in Open Heart, said: “Current clinical opinion widely acknowledges that the treatment of iron deficiency in heart failure not only improves patients’ functional capacity and symptoms, but most importantly, their quality of life. Treatment can also reduce time-consuming hospital visits for patients and costly readmissions for the wider healthcare economy.

“Our colleagues in Scotland, America and Europe have guidance that provides them with recommendations for treatment of these co-morbid patients, it is disappointing that we are lagging behind and do not have such standardised recommendations to refer to here in England and Wales.”

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