A "shocking" proportion of over-50s with common health problems like high blood pressure are having undetected heart attacks, based on a snapshot of a study funded by British Heart Foundation (BHF) and Innovate UK and presented at the British Cardiovascular Society annual conference in Manchester.
The study was carried out by University of Manchester and Manchester University NHS Foundation Trust researchers.
The discovery was made when researchers looked at early data from volunteers in the ongoing community-based EARLY-HF study in Greater Manchester. When heart scans were offered to the 550 volunteers aged over 50 with cardiometabolic issues, researchers discovered that nearly one in 10 people (nine per cent) had already suffered a heart attack without realising it.
Almost a quarter (23 per cent) had undetected or poorly managed heart or circulatory problems which required medical attention.
To take part in the study, people had to have at least two health issues from a list of seven which affect millions of people in the UK. These included high blood pressure, type 2 diabetes, coronary heart disease, the lung condition chronic obstructive pulmonary disease (COPD), the heart rhythm problem atrial fibrillation, obesity and chronic kidney disease.
The most common issues for study participants were pre-existing high blood pressure, which had already been diagnosed in 88 per cent of the study group, and obesity, which affected 70 per cent. Meanwhile 42 per cent of the volunteers had diabetes.
Led by Professor Chris Miller, Consultant Cardiologist at Manchester University NHS Foundation Trust and Professor of Cardiovascular Medicine at The University of Manchester, researchers wanted to understand the rate of hidden illness which had been unrecognised and untreated in this group.
They discovered almost two-thirds (60 per cent) had high blood pressure which was not under proper control or being effectively managed, raising their potential risk of a heart attack or stroke.
Among the study volunteers, 34 per cent were classified as living in an area that is among the top 20 per cent most deprived in England,1 while 28 per cent lived in an area among the 20 per cent least deprived. There were more men than women in the study, with males making up 59 per cent of volunteers.
The researchers suggest the rates of undetected health problems found in Greater Manchester are likely to be reflected in communities across the UK.
Dr Nicholas Black, British Heart Foundation Research Fellow at Manchester University NHS Foundation Trust and The University of Manchester, helped to run the study and presented the findings at the BCS conference in Manchester. He said:
"My colleagues and I were shocked by just how much unrecognised disease we found. While our study involves people who would be considered at higher risk of cardiovascular disease, finding so many people who had experienced a heart attack and didn't know it was not something we ever anticipated going into this study."
The Detecting EARLY Heart Failure in Greater Manchester (EARLY-HF) study aims to detect people at risk of developing heart failure earlier, within socioeconomically and ethnically diverse communities who may have reduced access to healthcare.
Heart attacks and other heart and circulatory issues, like those discovered in the study so far, can lead to heart failure - a condition which affects more than a million people in the UK and means the heart cannot pump blood properly, which can cause severe breathlessness and fatigue.
Most study participants (81 per cent) were recruited via their GP surgery, with another 12 per cent signing up after seeing a social media advert, and others recruited through community events or signposted to the project by family and friends.
Everyone involved in the study had blood tests, an ECG and a cardiac MRI scan, and answered questions about their health and medical history. These tests revealed that 125 people out of 550 (23 per cent) had a heart or circulatory issue that required medical attention.
On cardiac MRI scans, signs of scarring suggested that 46 people (nine per cent) had previously had a suspected heart attack. These diagnoses were confirmed by a consultant cardiologist, who looked over every scan. Letters were sent to people's GPs, and they were then referred on for further tests and treatment.
Researchers found that 331 people in the study (60 per cent) had a blood pressure reading of 140/90mmHg or higher - the usual threshold for a diagnosis of high blood pressure (hypertension).
While 27 of these were undetected cases of high blood pressure, 304 people (92 per cent of them) were known to have it when they joined the study, with 224 already taking blood pressure-lowering medication. The researchers say this suggests their treatment plan was inadequate, as it had not brought their blood pressure down to a normal level.
Blood tests revealed 162 people (30 per cent) had elevated levels of the protein NT pro-BNP - a sign that their heart was under strain.
The study continues to recruit people in Greater Manchester with at least two cardiometabolic conditions - related to the heart, blood vessels or metabolism.
Professor Bryan Williams, Chief Scientific and Medical Officer at the British Heart Foundation, said:
"These shocking findings should ring alarm bells for our healthcare leaders. They show that our current approach to prevention isn't fit for purpose, and too many people are slipping through the gaps as a result.
"All too often we see patients too late, when years of living with treatable risk factors like high blood pressure or high cholesterol have built up leading to heart attacks or heart failure. We have made huge strides in our ability to treat cardiovascular disease over the past 65 years, but right now we're missing opportunities to prevent it in the first place. The picture this study paints won't improve without a radical shift in how we identify and treat people at risk of cardiovascular disease."
Professor Chris Miller, Professor of Cardiovascular Medicine and Consultant Cardiologist at The University of Manchester and Manchester University NHS Foundation Trust, who leads the EARLY-HF study said: "These findings underscore the need to address disparities in cardiovascular disease detection, healthcare access, and outcomes, including by engaging people through non-traditional channels such as text messaging and social media."
The EARLY-HF study is supported by Innovate UK Greater Manchester Innovation Accelerator, AstraZeneca, and British Heart Foundation. The sponsor of the study is Manchester University NHS Foundation Trust.
