Case study from Innovation: early diagnosis in community settings

Breathlessness clinics increase early diagnosis of heart failure

8 December, 2022

What is the aim?

Studies have aimed to identify heart failure in people with breathlessness in primary care. Screening studies have found that almost 16% of people aged 65 or over who present to primary care with breathlessness have heart failure, mostly heart failure with preserved ejection fraction (HFpEF).1 2 Breathlessness is one of the hallmark symptoms of heart failure and its assessment is the first step in the new diagnostic algorithm for HFpEF.3 However, breathlessness can also have non-cardiac causes, making it difficult to identify heart failure on this basis alone.

What has been achieved?

In 2014, the National Health Service launched a national pilot programme to facilitate diagnosis of people experiencing breathlessness in community settings by referral from primary care. Breathlessness clinics, which are specialist-led diagnostic clinics in the community, can reduce the time to diagnosis from 16 to 5 weeks, allowing treatment to start earlier.4 The clinics have also helped to build relationships between primary and secondary care, improved patient experience and self-care, and reduced healthcare costs.


  1. van Riet EES, Hoes AW, Limburg A, et al. 2014. Prevalence of unrecognized heart failure in older persons with shortness of breath on exertion. Eur J Heart Fail 16(7): 772-77
  2. van Riet EE, Hoes AW, Limburg A, et al. 2016. Extended prediction rule to optimise early detection of heart failure in older persons with non-acute shortness of breath: a cross-sectional study. BMJ Open 6(2): e008225
  3. Pieske B, Tschöpe C, de Boer RA, et al. 2020. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur J Heart Fail 22(3): 391-412
  4. NHS England. 2016. Evaluation of the NHS Breathlessness pilots: report of the evaluation findings. London: NHS England
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The Heart Failure Policy Network is an independent, multidisciplinary platform made possible with financial support from AstraZeneca and Roche Diagnostics. The content produced by the Network is not biased toward any specific treatment or therapy. All outputs are guided and endorsed by the Network’s members. All members provide their time for free. The Network is hosted by The Health Policy Partnership .