Introduction 

Heart failure is a common condition that carries significant mortality and morbidity but these can be reduced by using recommended treatments titrated to doses that the patient can tolerate. 

Many patients remain undiagnosed and under-treated with adverse impacts on both quality and length of life. It is estimated that over one million people in the UK are living with heart failure and that there are around 200,000 new diagnoses every year (roughly 14 for every community pharmacy in the UK). An estimated 385,000 people have heart failure which is currently undetected, undiagnosed, and consequently untreated. Prevalence increases with age so an ageing population means these numbers are predicted to increase. 

Approximately 80 per cent of heart failure is diagnosed in hospital even though 40 per cent of people had symptoms that could have triggered an earlier assessment in primary care in the months prior to admission. 

Heart failure has a poor prognosis. Earlier diagnosis and treatment will help reduce the burden to both patients and the healthcare system. While there is no cure there are many interventions that will improve both mortality and, more importantly to many patients, the quality of life associated with living with heart failure. 

Heart failure rarely exists alone – 98 per cent of those diagnosed with heart failure in the UK live with at least one other long-term condition such as diabetes, kidney disease, hypertension, ischaemic heart disease, atrial fibrillation, or chronic obstructive pulmonary disease. 

The latest data from the National Heart Failure audit (2020/21) on 61,784 hospital admissions reported in-hospital mortality of around nine per cent and one-year mortality of 39 per cent. 

Lower admissions during the Covid-19 pandemic led to concern that patients were not receiving the care they needed or coming forward for diagnosis, leading to a delay in treatment. Being alert to undetected heart failure is therefore particularly important. 

There are many aspects of care that the community pharmacy team can implement using a patient centred focus to improve symptoms, medicines optimisation and adherence, support patient self-management and improve patients’ quality of life.