While Jeremy Hunt prepared Thursday’s Autumn Statement (17 November), the British Heart Foundation published research warning that progress in the treatment of cardiovascular disease is at risk of being reversed as a result of the continuing effects of Covid-19. The analysis hints at the size of the NHS’s challenge after the pandemic.
The impact of Covid-19 on NHS service delivery, the report says, has caused 30,000 excess deaths among heart patients in England. Between March 2020 and August 2022, there were 29,956 excess deaths involving ischaemic heart disease, the most common type. This is 14 per cent more than would have been expected pre-pandemic. It also suggests that coronavirus was likely a significant factor in these deaths during the peaks of the pandemic, because heart and circulatory risk factors raise the likelihood of severe illness and death from Covid-19.
However, the analysis shows that as Covid-19 cases and deaths have fallen, the numbers of cardiovascular deaths still remain well above what would have been expected. This is likely a result of the deadly impact of stretched NHS capacity, long hospital waiting lists and ambulance delays.
Between March 2021 and March 2022, when Covid cases and deaths fell, there were still 7,500 more deaths involving ischaemic heart disease than would have been forecast. Deaths involving heart failure, diabetes and other circulatory diseases were also significantly higher than their expected levels.
This consistent level of excess mortality, the report believes, is different to what has been seen in cases such as cancer or dementia. It reveals the damage the pandemic has wrought on the health service, and the failure of the NHS to meet its Long Term Plan commitments to cardiovascular disease.
“Even before the pandemic, progress towards those ambitions was stalling,” the report writes. “In its wake, the pandemic’s impact on the health system has contributed to a situation where 60 years of progress against death and disability from cardiovascular disease is now in danger of being reversed.”
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In August 2019, there were just 75 people in England who had been waiting more than a year for a heart procedure. By August 2022, that number had increased almost 100-fold, up to 7,467.
In total the cardiology waiting list has increased by 52 per cent since August 2019, up to 330,000 people. The British Heart Foundation forecasts that by April next year, this could increase a further 18 per cent, with almost 400,000 people in England waiting for a procedure.
The last time the waiting time standard for elective care was met was February 2016 and, worryingly, the British Heart Foundation’s survey found that a fifth of patients say their heart condition has deteriorated since the start of the pandemic.
And when it comes to emergency care, the picture is just as bleak. The targets for a category two ambulance call – the second-most urgent response, which includes suspected heart attacks and strokes – is 18 minutes. In the first year of the pandemic, cardiac hospital admissions dropped by a quarter, not because there were less heart attacks, but because more emergency patients were dying in the community rather than accessing emergency care.
In 2021, as people became confident in using NHS services again, cardiac admissions and referrals began to rise again. This saw ambulance services begin to rise to their current unprecedented levels. Since the start of 2022, the average category two ambulance response has taken more than 35 minutes, crossing over an hour in March 2022. Meanwhile the 90th percentile of ambulance responses, which is supposed to be 40 minutes, surpassed two hours this summer.
Downing Street is expected to ring-fence health service funding in Thursday's statement, but the British Heart Foundation is calling for the prioritisation of cardiovascular services, immediate wide-scale investment in the NHS workforce to address staffing shortages and retention, and restored funding into local authority services that tackle risk factors like smoking.
“Heart care is at [a] tipping point, with millions of lives hanging in the balance,” the report writes. “We need a National Heart Strategy – one that puts cardiovascular care back on the front foot, stops the causes of poor heart health in their tracks, and supercharges research for the cures of the future.”
[See also: NHS backlog tracker: How long are hospital waiting lists where you live?]