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Heart specialists at odds over Scots coronary care

DISPUTES between cardiologists are delaying access to new medicines and treatments for heart patients, a key Government adviser has claimed.

Speaking exclusively to The Herald, Dr Barry Vallance said it was not controlling costs that stopped patients getting access to new treatments, in a robust defence of the health service's record in coronary care.

Mr Vallance, a consultant cardiologist at Hairmyres Hospital in South Lanarkshire and lead clinician for heart disease for the Government, said disagreements between specialists about new drugs and treatment advances have led to a failure to adopt new European guidelines on emergency procedures and a new potentially life-saving drug.

He also said Scottish health boards have to consider the impact funding new therapies will have on budgets for other services, while English hospitals bill primary care trusts when they introduce something new, allowing them to be "a bit more gung-ho".

Mr Vallance was hitting back at criticisms voiced by leading Glasgow cardiologist Professor Keith Oldroyd in Monday's Herald. Mr Oldroyd cited new drugs and treatment advances which are available in England and other European nations, but not Scotland and blamed cost containment for the problem.

However, Mr Vallance said disputes among cardiologists about how patients should be treated had halted change.

He also sought to allay worries that Scottish patients are receiving inferior treatment, describing cardiology north of the Border as "second to none".

Failure to allow more heart attack patients to have an emergency angioplasty to open their blocked artery was among concerns raised by Mr Oldroyd.

Official European guidance now says there is a window of 120 minutes to perform the procedure after an attack, instead of the traditional 90 minutes. However, Mr Vallance said it had taken time to convince some Scottish cardiologists this was the right way forward.

"We have not been sitting on this, it is because the cardiologists did not agree," he said.

Once they reach hospital, patients actually get their procedure within a much faster target time-frame than in England, he added.

He said a new blood-thinning drug, which has been shown to improve survival chances among heart attack sufferers, is another victim of indecision. He said: "The cardiologists again could not agree. It was not that the money was not there."

He explained the consultants themselves thought the drug was expensive for "marginal benefit" so they did not want to sanction wholesale use from the moment a patient entered an ambulance and for an entire year after their attack.

However, the problem was reaching consensus on an alternative treatment system. He said it was important to do so as the Scottish Ambulance Service would want the policy to be the same for paramedics nationwide if they were to administer the drug.

He added it would cost £1.5 million annually to introduce the treatment, called ticagrelor, across the west of Scotland. He admitted the drug was being used in England.

"In Scotland we are cautious perhaps in making sure we have the full clinical evidence to implement something on a wide scale, there is an element of that," he added.

A new, less invasive form of heart valve surgery has not yet been performed in Scotland, despite being available south of the Border for five years and Mr Oldroyd said even now plans centred on giving it to a small number of patients.

However, Mr Vallance said the British Medical Journal had published some articles raising concern about the procedure, TAVI, being used too widely on patients with less complex health problems. "Cardiologists enjoy doing things," he said.

"The concern is that the bar gets lowered and people who should not be offered TAVI are offered it."

Tight controls will be placed on who receives the operation in Scotland, but Mr Vallance said this is not to do with cost.

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