Thousands of people with heart failure are probably going undiagnosed, the Healthcare Commission has warned.
Early treatment can reduce hospital admissions
A review of heart failure services found that the number of people reported to have the condition is 140,000 fewer than expected.
The findings suggest many patients are missing out on drugs that would slow the progression of the condition.
Experts said the introduction of a blood test would speed up diagnostic services and access to specialists.
Heart failure affects 900,000 people in the UK and is caused by a reduction in the heart's ability to pump blood around the body.
The condition can be extremely debilitating and up to 40% of patients die within the first year of diagnosis.
However, diagnosis of heart failure is difficult as many of the symptoms - tiredness, shortness of breath and swelling of the ankles and feet - can be confused with other similar health problems.
The Healthcare Commission looked at figures on the number of heart failure cases recorded in GP data in 2005/06 and compared them with national prevalence figures.
They found the numbers fell significantly short of what they expected, which could be due to problems with recording patient data on GPs' systems.
But equally, it could mean that some patients are not getting access to diagnosis and, in turn, treatment.
The review of 303 heart failure services found that in general, once patients were referred they received a good level of treatment.
Since 2003/04 there has been a reduction in the time patients have to wait to be diagnosed accurately and significant increases in the numbers of patients being prescribed drugs to control their symptoms.
Two-thirds of primary care trusts and hospitals scored "excellent" or "good" for their overall services to heart failure patients and a further 89 were assessed to be "fair".
However, 26 were scored as "weak" - a finding the Commission described as "worrying".
Anna Walker, chief executive of the Healthcare Commission, said: "Heart failure is a very serious condition. It is therefore very positive to see the improvements made since the last review.
"But our report suggests that not all those that need treatment are getting it.
"Primary care trusts and GPs need to monitor the number of patients they deal with in comparison to national statistics.
"Symptoms and treatments need to be recorded and followed up by GPs."
Professor John Cleland, chair of the British Society for Heart Failure and consultant in cardiology in Hull said: "If you see a cardiologist, very often a lot of these services are available to you but if you can't see a cardiologist you may be neglected."
He said often people were on strong medication for symptoms such as breathlessness and swollen ankles without ever having a proper diagnosis.
Widespread use of a blood test known as the BNP test would help to quickly diagnose more patients, he said, but very few health trusts had started to use it.
"The BNP test is very good for diagnosis in heart failure - it's the first rung of the ladder.
"It would be hardly any extra work and it would begin to sort out the patients who need extra investigation - it's the single biggest change we could make."
Jackie Lodge, head of heart care at the British Heart Foundation, said: "Heart failure patients in England currently do not have equitable access to services - some receive superb care for their condition, while others receive little.
"The BHF believes every heart failure patient has a right to be given high quality care so they can manage their condition and symptoms and maximise their quality of life."
Dr Terry McCormack, chair of the Primary Care Cardiovascular Society said heart failure was a difficult diagnosis which would be easier if trusts would back BNP testing.
"We have been fighting for ages for our trust to accept it, but there's a cost involved."