Heart failure can creep up on people.
“I never thought there was anything particularly wrong with me,” is how one patient, a man in his sixties, explained to me what it felt like before he was diagnosed. Like many people, his early symptoms – feeling sluggish, getting breathless – were non-specific. A regular runner, heart problems seemed unlikely.
“It reached the point where I was struggling to walk 100 yards,” he said. Even so, the diagnosis of heart failure came as a shock. It hadn’t even been on his radar.
Heart failure is serious. It means the muscle has weakened and isn’t pumping blood round the body properly. There are several possible causes but some of the main ones are coronary artery disease, high blood pressure and damage from a previous heart attack.
It’s highly prevalent in Scotland, affecting around one per cent of the population at any one time. Yet heart failure has a markedly lower profile than some other serious conditions, a situation doctors find frustrating.
The good news is that, while it can’t be cured, a heart failure diagnosis comes with a shining silver lining: new treatments that can transform patients’ lives. Thanks to advances in medications over the past 30 years and the efforts of heart failure doctors and specialist nurses, many people can live a full life for years to come.
The bad news is that many people are waiting much longer than they should for diagnostic scans, waits which campaigners warn can have significant consequences.
So how to deal with these delays in an NHS system beset by them?
Some doctors want to see heart failure treated with greater urgency, like cancer, and say waiting times targets would help.
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Dr Ross Campbell, a consultant cardiologist and senior clinical lecturer at the University of Glasgow, is one of a group of doctors who want to see heart failure given a higher profile and early diagnosis treated as a much more pressing priority.
“I believe suspected heart failure should be treated with the same urgency as suspected cancer,” he says.
“Heart failure, untreated, can have a similar or worse prognosis to many cancers.
“The earlier certain cancers are diagnosed, the better the treatment options and outcomes, and I think it’s very similar with heart failure. Untreated, heart failure can shorten patients’ lives and does so significantly.”
He points out that “thankfully we’re in an era where we’ve got fantastic treatments which can and do entirely change outcomes for patients – not just improving length of life and prognosis but dramatically improving quality of life”, but adds that the earlier treatment is started, the better for patients.
Trouble is, many patients aren’t getting treated quickly.
If they suspect heart failure, GPs do a blood test checking for elevated levels of certain hormones, produced when the heart muscle is under strain. According to clinical guidelines, a high level indicates that a patient should have an echocardiogram scan (echo), the key diagnostic test for heart failure. If the level is severely elevated, the echo should be done within two weeks; otherwise, it should be done within six weeks.
But most patients with suspected heart failure in Scotland are not being seen within those guideline times, or anything like in some cases. There’s a nationwide shortage of echocardiographers, who perform the scans. Waiting times for echocardiograms generally – they are performed for a variety of reasons besides testing for heart failure – are worryingly long. Nearly 25,000 people across Scotland are waiting for one and nearly 60 per cent of them are waiting more than 12 weeks. BHF Scotland says long waits have “a real and significant impact on people living with the condition” and that’s no exaggeration.
The risk for those with heart failure stuck on waiting lists is that their disease can progress, worsening to the point they have to be admitted to hospital, potentially leading to poorer outcomes.
Last year, Public Health Scotland started publishing information about heart failure through the Scottish Cardiac Audit Programme, revealing how long people were waiting in 2024-25. It showed that for high-risk patients, who should be scanned within 14 days, just over a quarter were getting scanned within that timeframe. The median wait was 25 days, rising to three months in some places, with some dramatic variations between health boards. For those who should be scanned in 42 days (six weeks), just over 34 per cent were being scanned within the guideline time. The median wait was 69 days (10 weeks), but for some, was 22 weeks.
Echocardiograms are not among the Scottish Government’s eight key diagnostic tests that come with a six-week waiting time target and BHF Scotland wants them included, to signify that access to the test is a priority and “increase the focus within health boards on addressing these long waits”.
But Dr Campbell would also like to see heart failure waiting times targets, as already exist for cancer, to help ensure shorter and more uniform waiting times for patients. “It would allow greater prioritisation of patients with suspected heart failure for this very over-demanded test, echocardiograms,” he says.
Not all medics love targets. Some say they interfere with clinical judgments about which patients should be prioritised. Dr Campbell acknowledges this, but believes “anything that allows us to prioritise resource towards heart failure would be a good thing”. He adds that “the medications work very quickly and we should be using every lever to make sure people can get access to them as soon as possible”.
This is hard to argue with. Tempting though it may be to view waits for heart failure diagnosis as just another manifestation of chronic problems in the NHS, a sentiment that can quickly induce a sense of anxious helplessness, the prevalence and seriousness of heart failure demand a different response. Cancer waiting times targets are not always met across Scotland – far from it – but the sharp political focus on them helps ensure that money and resources are forthcoming. Clinicians are entitled to ask why heart failure isn’t treated the same way.
No one expects miracles – we’re all too familiar with privations in the NHS for that - but it’s extraordinary that a serious condition affecting so many should still be struggling to be seen as the urgent priority it so clearly is.
Rebecca McQuillan is a journalist specialising in politics and Scottish affairs. She can be found on Bluesky at @becmcq.bsky.social and on X at @BecMcQ
