Atrial Fibrillation

Lord Rennard Excerpts

Wednesday 4th November 2015 Lords Chamber

[Lord Rennard (LD)]

My Lords, I draw the attention of the House to my entry in the Register of Lords’ Interests. I also congratulate the noble Lord, Lord Black of Brentwood, on securing this important debate. Approximately 900,000 people in England have been diagnosed with atrial fibrillation, or AF, and there are perhaps half a million people here with the condition who have not yet been diagnosed. The condition causes an irregular heartbeat and it is one of the most important risk factors for stroke, contributing to one in five strokes. If left untreated, AF increases the risk of stroke fivefold.

AF-related strokes are often more severe, with higher mortality and greater disability arising from them than from other strokes. The Global Burden of Disease Study in 2013 suggested that atrial fibrillation and atrial flutter resulted in 112,000 deaths in 2013, compared to 29,000 in 1990. So it is a growing problem. Treatment with anticoagulants significantly reduces the risk of stroke in people with AF, but according to the Stroke Association, almost half of all the people in the UK with AF are not receiving the full anticoagulation treatment which significantly reduces the risk of stroke.

The issues for us to consider, and for the Minister to respond to, must therefore begin with the question of whether greater attempts at screening, which could enable early diagnosis, could be justified in terms of lives saved. Patients often do not feel any symptoms when their heart rate changes. There are many causes of this but not all of them are obvious. Can we simply rely on many people turning up at their doctors with other concerns leading to the identification of this condition? For those who are diagnosed, is enough being done to promote these anticoagulation treatments, including those most recently developed?

Surveys suggest that patient access to novel oral anticoagulants is lower than should be expected, highly variable across the country and much lower than in other European countries. The National Institute for Health and Care Excellence produced an excellent atrial fibrillation quality standard in July, which was endorsed by the Department of Health. But there is real doubt over whether that standard is being properly applied uniformly and in a timely fashion. The evidence suggests not.

An NHS Improving Quality report estimates that just over half of people with AF are getting drug treatment in line with the recently updated best practice guidelines. A year ago, it produced a report which suggested that better care of people with AF could help prevent an additional 11,600 strokes and save the NHS as much as £124 million per year. It also suggested that full implementation of new best practice guidelines could prevent almost 28,000 strokes each year and lead to overall savings of £293 million for the NHS in England.

I hope the Minister will respond positively by telling us that there will be rapid progress towards full implementation of these best practice guidelines.