Reduce-HF: reducing inequalities in the primary care diagnosis of heart failure
Heart failure that is diagnosed at a later stage, in hospital, leads to worse outcomes and increased NHS costs. The REDUCE-HF study, funded by the NIHR School for Primary Care Research, analyses anonymised data from GP records to find out which groups of people are at high-risk of late, hospital heart failure diagnosis. It explores how long-term conditions, ethnicity, social factors, and geography affect place of diagnosis. Researchers from five universities are working together with patients, carers, clinicians, and communities to develop a risk prediction tool, inform clinical guidelines, and explore how innovative technologies and new approaches could support earlier heart failure diagnosis in the future.
Background
Reducing health inequalities is a priority for the NHS. One way to reduce health inequalities is to target early diagnosis and treatment to underserved populations. This is especially important for conditions like heart failure, when the heart cannot pump blood properly, which is associated with a reduced life expectancy and quality of life.
Around 65 million people are living with heart failure worldwide, including one million in the UK. Heart failure is the most common reason for hospital admissions in people aged over 65 and is often diagnosed at later stages during emergency hospital admissions.
Women, people from disadvantaged backgrounds, and those with long-term conditions (such as respiratory diseases) are more likely to be diagnosed with heart failure in hospital. However, many people experience both multiple long-term conditions and socioeconomic disadvantages. Detailed intersectional analysis, that explores how these factors interact and deepens our understanding of the barriers to timely diagnosis of heart failure is therefore crucial.
AIMS
Patients, carers, doctors, researchers and community groups will work together on this project. Researchers will analyse anonymised, linked primary and secondary care electronic health records to explore how multiple risk factors— such as deprivation, chronic illnesses like COPD, and social determinants of health—combine to influence the risk of hospital heart failure diagnosis. Together with patients, doctors and stakeholders, we will produce videos and infographics to study findings.
We aim to:
- Characterise disparities in primary care heart failure diagnosis
- Evaluate geographic inequalities in heart failure diagnosis by producing heat maps to show how frequently the heart failure blood test is performed when people present to their GP with symptoms that could be due to heart failure
- Focus on heart failure diagnosis in people with COPD and the use of the heart failure blood test in this group
- Evaluate existing risk prediction tools to understand how well they perform in people most at risk of hospital diagnosis
- Develop a risk prediction tool to facilitate early diagnosis in the most deprived community populations
How are the public involved?
Patients, carers and the public have been involved in all aspects of this study, from its early conception through to the development of the funding application. Indeed, our application for funding included a public co-applicant with experience of heart failure who is now a member of our study team.
Patient and public involvement and engagement (PPIE) contributors are embedded within each package of work and through a core PPIE group and Citizen Panels. We will host a final community event where we will work together with stakeholders and communities most at risk of late heart failure diagnosis to produce a video of the study findings and explore how new technologies and new approaches could support the early diagnosis of heart failure in the future.
Implementing research outputs
Together with patients, communities and stakeholders we will co-produce materials including videos and infographics to encourage patients to recognise and go to their GP earlier with heart failure symptoms, particularly in high-risk groups. We will invite heart failure charities to use these materials to target awareness campaigns effectively.
Study findings will be shared with the Heart Failure Policy Network, NHS England, Integrated Care Boards (ICBs), and NICE guideline development groups to inform policies addressing disparities in the diagnosis and management of heart failure. This will include tailored recommendations to improve diagnostic pathways in primary care using electronic health records. We will also co-design a future health technology implementation study, to enable timely heart failure detection through new community diagnostic pathways.
We will create a transdisciplinary research network across the SPCR strengthening primary-secondary care, stakeholder and industry collaborations.
We are recruiting
We are actively recruiting individuals from all backgrounds to join our core PPI group and as community research link workers. If you’re keen to know more please contact: Email: ppi-reduce-hf-study@bristol.ac.uk Phone: 0117 455 8823
If you have a question or are interested in more information about the study in general please email reducehf@phc.ox.ac.uk
Project Members
Collaborators
Bristol University (Centre for Academic Primary Care)
Rachel Johnson, Associate Professor in Primary Care
Charlotte James, Senior Research Associate in medical statistics
Rachel Denholm, Senior Lecturer
Marwa Al Arab, Senior Research Associate in Medical Statistics and Health Data Science
Amy Dillon, Senior Data Access Manager
Olivia Skrobot, Senior Research Associate in Evidence Synthesis
Laura Jefferies, Academic Administrator
Keele University
Caroline Mitchell, GP and Professor of General Practice Research and Health Equity
Nottingham University
Barbara Iyen, Clinical Associate Professor
Birmingham University
Clare Taylor, GP and Professor of General Practice
Length of project
This project will run until December 2026
