Atrial Fibrillation

Baroness Gardner of Parkes Excerpts

Wednesday 4th November 2015 Lords Chamber

[Baroness Gardner of Parkes (Con)]

My Lords, I suppose I should declare an interest. Some years ago I was told that I had mild atrial fibrillation—it might have been named intermittent. Now, it is clearly stated that I have permanent atrial fibrillation. I am aware of this diagnosis and the fact that it means my heart is less efficient. Noble Lords have heard everything from everyone else about that. I take Warfarin daily to keep my international normalised ratio within appropriate levels recommended by my cardiologist. It seems to be effective, but regular monitoring through blood tests is required to ensure that my INR remains as it should. The test is straightforward and involves a finger prick to obtain a blood sample, which is put into a reading system that provides the answer. The dosage of tablets is then increased or decreased to correct an unsuitable reading. It is the sort of test that people with diabetes—particularly type 2—need to carry out several times a day.

Yesterday, I discussed this with a distinguished Member of your Lordships’ House who has been in exactly this position—as a type 2 diabetic—for some years. He said he gets warnings: when he feels that he is getting muddled, that means that his blood sugar is low and it is time for another test. If he is feeling slothful and lethargic, his blood sugar is high. He has to do this test up to five times a day and carries out these procedures himself; he has no problems with this. Why is it that individuals requiring very similar blood tests for atrial fibrillation are not able to do their own tests in this same way?

Over the years, I have raised this question, especially with my noble friend Lord Howe. In his days as Health Minister, he told me that it would be logical for those who wished to self-test to do so. I was informed that this would help to reduce National Health Service workload, and sure enough, the INR clinics are always very busy and in demand in most of the major hospitals and in many general practices. The NHS supported self-help, according to my noble friend. In that case, why is there not more self-monitoring for atrial fibrillation? Is this still the case?

For some years, manufacturers of self-test appliances have provided demonstrations in the House of the simplicity and effectiveness of the process. There would be considerable savings for the NHS if patients bought their own machines—I believe that many would—and the NHS provided the small disposable items needed for the tests, such as finger-prickers and solutions. At present, different areas of the NHS provide others with different items. In some areas, the situation is very unsatisfactory for those who feel they should have access to these items. If there were just one system and all the patients therefore had the same choices, there would be a considerable saving.

Mention has been made of the drugs that could be taken instead of Warfarin. My cardiologist said, “Don’t do that”, because the good thing about Warfarin is that its effects are reversible if you suddenly find that your reading is much too high or too low. However, the effects of these new tablets—which have been referred to as NOACs—are not reversible. You have to wait until the body gets rid of them, so there is a time-lag and the situation could become quite dangerous.

In Australia, children born with heart conditions have such machines loaned to them, so that all the treatment can be administered at home. Again, that is very important. My noble friend Lord Black mentioned the difficulty a lot of people face in getting to a hospital. I hope the Minister will support the view that there should be access to self-monitoring.