Diagnostic Challenges and Demographic Disparities in Heart Failure Care

A retrospective cohort study of over 400,000 patients reports substantial underuse of guideline-recommended heart failure investigations and marked demographic disparities.

Natriuretic peptide testing (BNP/NT-proBNP), echocardiography, and basic ECG assessment with documentation were markedly underused in primary care. Deficits were larger in community settings than in hospitals, increasing the risk of missed or delayed diagnoses.

Women, people living in more deprived areas, and South Asian patients experienced wider inequalities in access to investigations and referrals.

Delayed diagnosis—or diagnoses made only after hospital admission—was associated with worse survival in the study cohort.