Aortic Dissection: Patient Pathways and Research Funding

Feryal Clark Excerpts

Tuesday 13th December 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Pritchard.

I want to take a moment to sincerely thank the hon. Member for Mid Derbyshire (Mrs Latham) for securing this debate and for sharing her very personal story. I offer my profound condolences to her for the loss of her son, Ben, and I recognise her extraordinarily brave work in campaigning to improve the patient pathway for aortic dissection, and to increase research and screening.

As we have heard, aortic dissection occurs because of a partial tear in the wall of the aorta. The tear then spreads, and can rupture or interrupt the blood supply to vital organs. There are two distinct types of aortic dissection: type A, which occurs in the front of the chest, and type B, which occurs in the back of the chest. Type A is far more dangerous; if untreated, it is sadly almost always fatal. We have also heard today that over 2,000 people per year lose their lives from aortic dissection. Some 11% of maternal deaths from cardiovascular causes are due to aortic dissections. Worryingly, the Oxford Vascular Study projects that those figures will almost double by 2050. It is crucial, then, that we engage with experts and give this life-threatening condition the attention that it deserves.

As the hon. Member for Mid Derbyshire said, there have been some positive advances in aortic dissection care over the last year—notably, the launch of the acute aortic dissection toolkit—but we cannot afford to take our foot off the pedal. Deaths from aortic dissection are avoidable, and with timely treatment the survival rate is good, as we have heard. It is therefore crucial that we do everything we can to drive up diagnosis rates. The Aortic Dissection Charitable Trust estimates that one in three of those who have aortic dissection are misdiagnosed. I would be grateful, then, if the Minister will update colleagues on the steps her Department is taking to improve diagnosis rates for aortic dissection.

The ADCT has made the case for a review of A&E triage processes, imaging, diagnosis and transfer for surgery. Notably, it also advocates diagnosis being made pre-hospital, which bypasses emergency departments and saves vital time. That work already happens with acute coronary syndrome and acute heart attacks. The ADCT states:

“The current pathways are ineffective… There are problems transferring images… Medical management, blood pressure control, imaging protocols, investigation of genetics…and long-term follow-ups are all sporadic and often not addressed well.”

The AAD toolkit has made a positive difference to some of those problems, but there is still much work to do. Has the Minister met with ADCT recently to review pathway processes? In addition, what work is taking place to eliminate regional variations in aortic dissection care, and to streamline aortic care so that patients can be seen before it is too late?

I also wish to highlight preventive interventions and why it is important that the Government support diagnostics to enable clinicians to save lives. Genetic screening, functional imaging and biomarker analysis are now possible, and if used efficiently, they enable clinicians to provide treatment before an aortic dissection occurs. As the hon. Member for Mid Derbyshire highlighted, once a patient is identified as having a family history of the disease, there is scope for potentially life-saving genetic screening. The ADCT estimates that 20% to 30% of families with dissections have an identified gene. Work is ongoing to identify the remaining 70% to 80% of genetic causes, but if we can screen that 20% to 30%, potentially thousands of lives could be saved over the next few years. I am sure that both sides of the House will agree that that is a worthy endeavour. Will the Minister therefore clarify what steps she is taking to support those exciting and potentially life-saving diagnostic tools?

Finally, let me touch on the workforce. We know that the NHS has the facilities to treat those suffering from aortic dissection. The problem lies in diagnostics. The reality, however, is that system-wide pressure on the NHS exacerbates misdiagnosis and compounds issues in patient pathways. It is therefore essential that targeted aortic dissection strategies come alongside whole-system workforce overhaul.

The next Labour Government will oversee the biggest expansion of the NHS workforce in history, doubling the number of medical school places, training 15,000 new doctors, creating 10,000 new nursing placements, and recruiting 5,000 new health visitors. That will be paid for by abolishing the immoral non-dom tax status. I encourage the Minister to nick Labour’s idea and commit to implementing that workforce strategy as soon as possible. Unless we solve the systemic workforce shortages, we will not be able to robustly tackle conditions such as aortic dissection.

In conclusion, I want to see a future where aortic dissection is diagnosed quickly, treated rapidly, and receives appropriate long-term care and management.