Atrial Fibrillation

Lord Plant of Highfield Excerpts

Wednesday 4th November 2015 Lords Chamber

[Lord Plant of Highfield (Lab)]

My Lords, most of what needed to be said has been said. I echo everything that noble Lords have said about the initiative by the noble Lord, Lord Black, and I am very pleased that he called for this debate. Like other noble Lords, I have had AF for a very long time—20 years or more—and I have been taking warfarin every day, along with a low-dose aspirin, for 20 years. This medication was changed recently and I was rather nervous about it. The aspirin was replaced by clopidogrel. So far no adverse effects have been detected, but it is a bit of a big thing when you move from one medication to another.

I am pleased that in its guidance NICE says that there should be proper consultation between the patient and the cardiologist about any sort of medication. I wonder whether an organisation such as the British Heart Foundation could produce one of its short pamphlets explaining the action—the function—of these drugs in a fairly straightforward way. I hope that I am a person of at least moderate intelligence, but I did find parts of the NICE guidelines completely incomprehensible. It would be worth having a leaflet setting out the pros and cons of different kinds of therapy.

Given that a lot of people—most people, probably—will stay on warfarin for the foreseeable future, I am worried by its prescription into quite old age and the risk of falling. If you fall and your blood is very thin, the chances of having some kind of bad event are quite strong. I remember—as will many members of this House—our friend Donald Dewar, the former Secretary of State for Scotland, who fell over in a frosty street in Edinburgh and died as a result of a brain haemorrhage. He was on warfarin: it was a contributing factor. So it is important that we consider knocking off warfarin for elderly people and perhaps replacing it with some of these NOAC drugs, so long as they do not have the same sorts of risks. Perhaps they do.

There is another thing that happened to me recently that perhaps the Minister could think about, although not necessarily today. It is where you have atrial fibrillation and you have a stroke. I had a stroke in November 2014, which badly affected the sight in my right eye, and almost immediately after the stroke, which was caused by AF—they knew that because I was in hospital at the time and my heart was in atrial fibrillation when I had the stroke—I had a carotid artery endarterectomy. That was a slightly alarming operation, to put it mildly, but it seems to have helped things along. How routine is offering carotid artery surgery to otherwise fit patients who have had an AF-induced stroke? It would be useful to know whether it is pretty routine or an exceptional thing.

I have been fortunate since I have had all this trouble to have lived in Oxford, where there is an exceptional cardiology department, and now Southampton, where there is a regional centre for cardiology. I just wonder how far the ease with which my symptoms and the carotid artery operation were dealt with was due to the fact that Southampton is a regional centre, or whether you could get that kind of treatment in a much smaller hospital. It would be useful to have some indication of that. If the Minister could write about that, I would be very pleased.