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Stronger pharmacist involvement in heart failure (HF) is needed to tackle “one of the major health challenges of this century”, a report from the Alliance for Heart Failure (AHF) has said.
The report, ‘Transforming heart failure services in the community’, was published by the coalition of charities, patient groups, professional bodies and healthcare companies that make up AHF on 5 December 2025. It makes two formal recommendations for expanding screening via pharmacies and community diagnostic centres (CDC) and supporting primary care to better optimise medication in the community.
With around 1 million people currently living with HF across the UK and a further 200,000 new diagnoses each year, the report specifically calls for integrated care boards (ICBs) and community pharmacy providers to integrate HF screening into the NHS blood pressure check service.
The report said that standardised HF symptom questions should also be included in blood pressure checks, creating an additional opportunity to identify patients at risk during routine community encounters.
It has also called for NHS England and ICBs to expand and establish pharmacist-led HF medicines optimisation clinics within pharmacy settings. It said these clinics should provide timely medication titration, patient education and monitoring, integrated closely with primary care and specialist teams to enhance patient outcomes, reduce hospital admissions and optimise the use of guideline-directed treatments.
The report says: “Historically, HF has not received the same emphasis on prevention, diagnosis and treatment as other major conditions, despite the disproportionate impact on patients, the NHS and the economy.”
It suggested that this is because “[HF] has traditionally been seen as a complex condition, often misunderstood as being solely associated as a condition of [older people] associated with end-of-life care”.
“The full potential of this revolution in HF care has yet to be fully realised across the NHS,” the report claimed — something it said was “particularly evident in primary care”.
“A significant number of primary healthcare professionals remain unaware of diagnostic pathways, treatment and rehabilitation available,” it said, adding that — despite knowledge of the condition among GPs — “early detection is not currently prioritised”.
As a result, the report says this is placing an “unsustainable burden on hospitals across the country, [with] 80% of HF cases diagnosed in hospital, despite half of those having had signs and symptoms that should have triggered an earlier assessment and access to life saving therapies”.
The report has also cited several case studies and suggests solutions to address the problem of late diagnosis and slow treatment options for HF, which make use of pharmacists and pharmacy expertise.
Referencing the government’s NHS ten-year health plan that is aimed at giving community pharmacies a bigger role in prevention by expanding their role in screening for risk of cardiovascular disease, the report says “an easy win” is to build on the existing hypertension case-finding service to expand HF screening.
“Hypertension has a high population-attributable risk for HF, accounting for 39% of cases in men and 59% in women.
“Additional questions to aid in the detection of HF, with the option to refer for an NT-proBNP test at either a GP or a CDC, would significantly expand diagnostic screening of undetected heart failure cases, particularly in high-risk areas.”
Writing in the report’s preface, Jim Moore, a GP with a specialist interest in cardiovascular medicine and immediate past president of the Primary Care Cardiovascular Society, said: “HF care has long been reactive — focused largely on treating patients in hospitals rather than earlier diagnosis and optimisation of care in the community. This approach is no longer sustainable.”
Paul Wright, lead cardiac pharmacist at Barts Heart Centre, told The Pharmaceutical Journal he is “really supportive” of the document as it raises several aspects of pathway optimisation that need to happen to improve outcomes in patients affected with heart failure.
It “recognises the significant impact that pharmacy” can have on improving health outcomes, he added.
“Given the wide impact of community pharmacists in supporting hypertension detection, a simple questionnaire regarding heart failure symptoms would seem a minimal effort with maximum gains to encourage NT-pro BNP testing in appropriate individuals”, he said.
“Depending on accessibility, this could also be through point-of-care testing to further streamline those individuals that need rapid assessment.”
Wright added that there is “a wealth of data” demonstrating pharmacy-led optimisation clinics achieve “rapid and optimal” medication titration of guideline recommended medical therapy.
“We are seeing more data specifically in heart failure clinics,” he said.
“Locally, we have demonstrated the impact of a virtual clinic model to rapidly up-titrate and initiate the four pillars of HF therapy in the STaRT HF clinic, which has demonstrated reductions in admissions, reduced need for cardiac devices, improvements in LV function and excellent patient feedback. This model is the future of heart failure titration.”
