The Pumping Marvellous Foundation is pleased to support The Other Side of Heart Failure, which highlights the need to improve recognition, diagnosis and care for people living with heart failure with preserved ejection fraction (HFpEF) and transthyretin amyloid cardiomyopathy (ATTR-CM), conditions that can remain under-recognised within current pathways.

Heart failure is a major health challenge in the UK, with 1 million people have heart failure and an estimated further 400,000 have undiagnosed heart failure and demand on services is expected to continue rising over time.

Around half of people living with heart failure have HFpEF. People living with HFpEF can experience delayed recognition, inconsistent pathways and variation in access to support. Patients with ATTR-CM, an important underlying cause of HFpEF which is estimated to be present in 11% of HFpEF patients, may face long and complex diagnostic journeys.

These challenges point to the need for a more coordinated, system-wide response. Delays in diagnosis and variation in access to care continue to impact patient outcomes and experience.

We welcome the report’s focus on practical solutions, including strengthening diagnostic pathways, improving coding and data, and enabling more consistent, community-based care.

We support the report’s focus on ensuring HFpEF and ATTR-CM are within wider cardiovascular disease strategies, including the implementation of the CVD Modern Service Framework.

By addressing these gaps, there is a clear opportunity to improve outcomes, reduce inequalities in access, and ensure that patients receive timely, appropriate and equitable care.

The report sets out seven policy recommendations:

Immediate priorities
1. HFpEF and ATTR-CM should be prioritised as part of the early implementation of the high-impact interventions defined within the CVD Modern Service Framework.
2. The Quality and Outcomes Framework (QOF) should be updated to include specific indicators for the diagnosis and management of HFpEF, supporting parity with HFrEF and accurate coding of heart failure sub-types.
3. The Government’s commitment to establish a networked care model for amyloidosis should be fully implemented, with regional centres sufficiently resourced to address inequalities in access to specialist amyloidosis care.
4. Red flag symptoms for ATTR-CM should be incorporated within primary care IT systems to encourage practitioners to “think ATTR-CM”.

Medium-term
5. There should be regular evaluation of the roll-out of NHS England’s HFpEF pathway support tool to ensure consistent uptake across ICBs.
6. The upcoming NHS workforce plan refresh should be used to adapt traditional cardiology workforce models and empower wider members of the multidisciplinary team to take a more active role in heart failure diagnosis and management.
7. NICE should update the Quality Standard for Chronic Heart Failure in Adults to reflect developments in the care and management of people living with HFpEF.

You can read the full report here.