Atrial Fibrillation

Glyn Davies Excerpts

Wednesday 12th March 2014 Westminster Hall

[Glyn Davies (Montgomeryshire) (Con)]

I am grateful to have the opportunity to speak in a debate that is hugely important to me on a personal level. I agree with every word of the speech by the hon. Member for Huddersfield (Mr Sheerman).

Soon after I was elected as a Member of Parliament in 2010, I was selected for Question 1 at Prime Minister’s questions. I immediately thought that that was going to be my great occasion. One knows that one is on national television and everyone is watching. It is a chance to support the thrust of the Prime Minister’s argument and I was really looking forward to it, but on the Monday morning I called my GP, because I had been suffering a bit of breathlessness, and I was rushed into hospital because he thought that I was having a heart attack. This is what influenced me greatly. I then spent three days in the assessment unit of the Royal Shrewsbury hospital, and it was probably the most expensive bed in the hospital.

As I said, I was there for three days with a supposed heart attack. No one was telling me what was happening. It was only because I became so angry that I almost had a heart attack that I had some reasonable treatment, and I was told that I was probably suffering from atrial fibrillation. I had never heard of this; I did not know what it was, but as I got to know a little more about it, I learned how, in many cases, it is very easy to put right. I was given electric shock treatment—cardioversion—which reversed the fibrillation on the first attempt, and I made a full recovery, but I learned quite a lot about the condition and I realised the sheer lack of awareness that there is of it. Then I understood what the hon. Member for Huddersfield has been telling us. The issue is not so much the atrial fibrillation itself—although it can be quite difficult for many people—but what it causes. It multiplies the chance of a stroke by about five times. That is a massive cost to the NHS, but it also completely destroys people’s lives in a way that AF does not necessarily do. There are several other diseases associated with it, but the key issue is the implications of the cost of a stroke.

[Richard Graham (Gloucester) (Con)]

My hon. Friend is making a powerful point on an important issue. Those of us who work right next door to him are delighted that he made a full recovery at that time. Does he agree with me that part of making people more aware of atrial fibrillation and what can be done to help sufferers is providing defibrillators? Some very good work has been done across the country, but particularly in my constituency of Gloucester by the Rotary club, which has funded and installed a defibrillator in Gloucester cathedral; and I pay tribute especially to the Hickman family, who have raised huge amounts of money for the Cystic Fibrosis Trust, which is also doing good work in this area.

[Glyn Davies]

I certainly do agree with that. Defibrillators are being installed, through voluntary efforts and fundraising, in many parts of the country. That is not only a good thing in itself, but the way it leads the community to work together is also a very good thing.

I want to return to today’s issue, because I am aware of the time. Today’s issue is the uptake of novel oral anti-coagulants. Warfarin was my treatment and it was fine; it worked very well. However, there is a problem because of the number of occasions I have to visit a hospital. It was once or twice a week in the early stages. That is very difficult. In London, I happen to live next door to St Thomas’s and I could pop in as I was going to work in the morning, so it worked out quite well.

However, there is an issue with warfarin, for two reasons. One is that it is not as effective as the new anti-coagulants that have been approved by NICE and come on stream. Also, there is a negativity about warfarin because it is, in many people’s minds, a rat poison. I remember seeing a headline in a national newspaper, which could have been the Daily Mail, with a huge picture of rat poison—warfarin. The standard way of dealing with atrial fibrillation is still to ask people to take warfarin regularly, and there it was, being promoted as a rat poison. Nothing could be more damaging to the health of the nation than that campaign. I thought it was a disgrace.

I can understand in a way, because of short-termism—the way in which things are often done in Britain today—that there are financial reasons for the use of warfarin. Clearly, there is an extra cost associated with the new products. Warfarin is as cheap as chips. I dismiss aspirin because it does not have any effect anyway, and it is a bit of a disgrace that aspirin is still being recommended. As I said, warfarin is as cheap as chips, but of course it is not as effective. There may be a short-term gain, but there is a long-term cost. I understand the financial pressures. There are financial pressures on every organisation and service. I understand those, but I think that what is happening is wrong. However, the lack of understanding and knowledge of the new products—the lack of awareness—is what we really have to challenge.

There is a risk element. We know that there is a risk. There is a small risk, if one s thinning the blood, of an internal bleed, but there is a very large risk, in not doing it, of causing some heart-related illness. The balance of risk is just not clearly understood. We need a genuine campaign, with Government support and the NHS organisations’ full support, to move towards use of the novel oral anti-coagulants. There would be a long-term saving from that; I accept that it is not short term. It would remove the element of suspicion and of risk that is associated with the standard use of warfarin.

We have to deal with AF, because the numbers of people suffering from it and the implications of it are huge. I hope that my hon. Friend the Minister will take from today’s debate, which is part of a campaign, the message that we need to move forward as quickly as possible on the best treatments for atrial fibrillation.

--- Later in debate ---

[Dr Poulter]

The statistics that I am aware of are slightly less positive than those that the hon. Gentleman has cited. It is not for us in this place to micromanage medical professionals or to do their jobs for them. However, it is our job to raise legitimate concerns about care for AF or any other health conditions. We must do our best, as stewards of the health system, to push for good local commissioning that is mindful of best practice. I have undertaken to write to NHS England about that, and I will be happy to share the reply that I receive with the hon. Member for Huddersfield and other hon. Members and hon. Friends.

The exact causes of AF are unclear, but it is important to get the diagnosis right and to diagnose the condition as quickly as possible. We believe that some 18% of cases of AF are undetected, so there is more work to be done. NHS England has recognised that, and has suggested that CCGs should work with local practices to target people who are at risk from AF. The issue is already on NHS England’s radar, but I will write to obtain further assurances that it is being taken as seriously as it should be; I am sure that that is the case.

Research is under way into the condition. The National Institute for Health Research is funding a study into automatic diagnosis of AF in primary care using a hand-held device, which may help identify more patients who have AF and reduce the number of related strokes. If someone does not know that they have the condition, they do not know that they need to see a GP to get help. We must do as much as we can to support people to recognise that they have a medical condition and that help and treatment are available. I hope that the research into that technology provides better early detection of AF, and that that comes forward in a rapid and timely manner.

[Glyn Davies]

I thank the Minister for giving way and allowing me to correct an omission in my contribution. Does he agree that the excellent work of the Atrial Fibrillation Association in promoting knowledge of the disease has had a hugely positive impact, which we should all appreciate?

[Dr Poulter]

My hon. Friend is absolutely right to highlight that work. When NICE draws up guidelines, it consults best practice and tries to engage with key stakeholders. In addition, the Royal College of Physicians has developed some national clinical guidelines for stroke with the objective of encouraging higher levels of anti-coagulation. That is directly linked to some of the things we have debated today.

It is a testament to the work of groups such as the Atrial Fibrillation Association that we are helping to raise the profile of the condition and to get early support and help for people. There is clearly more to do, and NICE must continue to develop strong guidelines to support understanding of the best care and pathways for people who have AF. NICE is updating guidelines at the moment and developing a quality standard on AF, which will set out what a high-quality AF service should look like and drive improvement locally by helping local commissioners and CCGs understand what good looks like in AF care.