A heartfelt appeal

As World Heart Day 2026 approaches, BHF Scotland urges Scottish ministers not to “miss a beat” by putting in place a national plan to strengthen cardiology services

When a patient has suspected heart disease, getting a firm diagnosis cannot wait. Patients need timely assessment, followed by treatment tailored to their needs.

But while many patients in Scotland are being diagnosed and treated within guideline times, there is deepening concern about the significant numbers who aren’t.

Cardiology waiting times – the time it takes for patients to see a cardiologist in an outpatient clinic after being referred by their GP – are much higher than before the Covid pandemic and with an ageing population, the pressure is only going to increase. 

BHF Scotland is now calling for action to make Scotland’s cardiology services sustainable for the long term. “What we hear from clinicians is that they are trying to continue to provide a good level of care in a challenging system and you can see based on the projected growing burden of disease that that is just going to get harder and harder,” says David McColgan, head of BHF Scotland.

With the Scottish Government’s Heart Disease Action Plan now having come to an end, campaigners are calling for a national cardiology transformation plan, backed by investment, workforce planning and clear action to reduce cardiology waiting times and plan services for the future. A plan is needed not just to drive down specific waiting lists, they say, but to address the root causes of delays and bottlenecks in the system, reduce avoidable hospital admissions and improve outcomes for patients. 

Their call comes as World Heart Day on September 29 puts the spotlight on cardiovascular disease as the number one cause of death globally. In spite of affecting an estimated half a billion people worldwide, many countries around the world, including Scotland, do not have a standalone national plan for tackling it. World Heart Day’s theme, Don’t Miss A Beat, is aimed at encouraging people to learn about and act upon signs of heart disease that can go unnoticed, such as high blood pressure or serious fatigue, and to demand action from their governments. “Cardiovascular disease (CVD) is the world’s most urgent health crisis but is often overlooked by leaders,” according to the World Heart Federation. They stress that without national CVD action plans, the number of deaths will keep rising.

The Scottish Government has taken important steps forward in its approach to heart disease in recent years, including improving data collection through the Scottish Cardiac Audit Programme and preventing disease by identifying patients at higher risk through the Cardiovascular Disease Risk Factors Programme. BHF Scotland wants to build on those successes. The Scottish Government is currently developing a Long-Term Conditions Framework to take a unified, cross-cutting approach to tackling chronic illnesses, including cardiovascular disease, and BHF Scotland is calling for a strategic focus within it on CVRM (cardiovascular disease, renal and metabolic conditions, since they share many of the same risk factors). 

But they stress that a speciality focus on cardiology services must be maintained in order to drive down waiting lists and improve access to timely diagnosis and treatment for patients. 

Cardiovascular disease continues to be one of the biggest causes of ill-health and mortality in Scotland. For hundreds of thousands of people, it’s a daily challenge and for some, a seriously debilitating condition. It can impact people’s ability to go to work, to care for their families and do the things they love to do.

While there have been important advances in heart disease treatment in recent years, the challenge remains getting patients the care they need quickly enough. The latest figures, from July, show that 19,182 people in Scotland were on the waiting list for a new cardiology appointment and nearly 43 per cent of them were waiting more than 12 weeks. That compares to 8,824 patients on the list in March 2020.

But those figures, worrying though they are, don’t tell the full story about the pressure cardiology services are under. 

If people don’t have access to prompt diagnosis and treatment, they end up in hospital more often and they end up with worse outcomes - David McColgan, BHF Scotland

Waiting times for echocardiograms, which are used to identify a range of conditions including heart failure, have also been growing. The latest figures show that nearly 25,000 people are waiting for one, with 60 per cent waiting more than the maximum guideline time of 12 weeks. A shortage of specialist echocardiographers lies behind the delays.

Patients awaiting scans and cardiology appointments may be taking medication, but it’s only when expert clinicians have access to a complete battery of test results that they have the full picture of what’s happening to a patient and can proceed with a definitive, tailored plan. Patients with heart failure, for instance, require a complex regime of drugs titrated to their individual needs. That, combined with the ongoing support of heart failure specialist nurses, can make a dramatic difference to quality of life. 

If, however, patients are stuck on a waiting list without a clear diagnosis or treatment plan, their condition can deteriorate.

“If patients don’t have access to prompt diagnosis and treatment, they are likely to end up in hospital more often and the outcome for them can be worse. It’s not good for patients and it’s not good for the NHS,” explains McColgan. “Patients end up in unscheduled care: they end up in the system anyway and in the places that are already under acute pressure.”

Unscheduled care – hospital admissions that are unplanned and caused by sudden illness or the worsening of a pre-existing condition – is a major cause of pressure on hospitals. Surges of unscheduled care can have impacts throughout a hospital and health board area. 

Cardiovascular disease is a common cause of unscheduled care. In 2024/25, there were 22,516 hospital stays for coronary heart disease, 9,621 for atrial fibrillation and 7,727 for heart failure. The stays can be lengthy. When someone with heart failure is in hospital, for instance, they tend to stay much longer than the average inpatient (13.48 days compared to 4.03 days). Yet many heart failure-related hospital stays could be avoided altogether through earlier detection, diagnosis and treatment.

BHF Scotland wants to see further investment to future-proof stretched cardiology services, pointing to the £13m recently allocated by ministers for a gynaecology improvement plan as a comparator. The charity stresses ministers would be investing to save, highlighting the significant savings that could be unlocked by reducing levels of serious illness and unscheduled hospital stays. 

Workforce shortages, meanwhile, remain a major challenge. BHF Scotland wants to see a strategic national approach to training echocardiographers and cardiac physiologists (clinicians who carry out and analyse tests), implementation of the national framework for training specialist cardiac nurses, and careful forward planning to ensure roles are not left vacant.

They also want a more joined-up approach to tackling consultant shortages, particularly hard-to-fill vacancies in smaller hospitals and rural areas. 

With Scotland’s health boards set to be merged, the charity wants to see this made a priority. Some cardiology services are already organised across geographical boundaries, says McColgan. For example, specialised procedures such as stenting are performed by six hospitals across Scotland, with agreements and pathways in place for referrals from other heath boards.

“It’s about taking a collaborative approach to some of these problems,” he says.

With change in the NHS coming, clinicians see an opportunity for much-needed improvement.

“There’s definitely a willingness to get together to bring about improvements and what’s probably been missing is that operational support for clinicians to allow this to happen,” says McColgan. “If we can bring together the clinical momentum to improve and drive things, alongside the government with its convening role, power and investment, and the operational support from hospitals, then these problems could be fixed.”

Waiting list figures offer clear proof of the pressure cardiology is under. Demand is increasing and a transformation plan for cardiology cannot wait.

McColgan says: “It’s never going to get any easier so we need to get in front of it as much as possible. 

“The time is now.”

This article is sponsored by British Heart Foundation