The health watchdog has revealed thousands of people with heart failure may have been missed by the system.
A Healthcare Commission study shows that the number of people reported as having heart failure is around 140,000 fewer than expected.
And while this could be down to a lack of clear auditing, it could also mean patients are not being diagnosed or obtaining the correct drugs.
About 40% of patients suffering from heart failure die within the first year of diagnosis.
The research found more than a third of services in England are either fair or weak, despite some "very positive" progress since the last report in 2003-04.
The report also said primary care trusts have a problem collecting data around the condition, as of the 303 questioned, only 204 could provide any figures.
Healthcare Commission chief executive Anna Walker said: "Heart failure is a very serious condition.
"Waiting times for diagnostic tests have improved and patients now have better access to effective treatments.
"Most communities also now have access to specialist services, with almost two-thirds of those we reviewed scoring "good" or "excellent".
"But our report suggests that not all those that need treatment are getting it.
"Heart failure currently costs the NHS £625m a year.
"But if we can improve all elements of the service, this will be better for patients and improve the use of resources."
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