Victims of heart attacks denied life-saving drugs

Health Correspondent

Monday 24 September 2012

HEART attack patients in Scotland are repeatedly being denied the latest life-saving treatments to save money, a leading cardiologist has warned.

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Helen Puttick Health Correspondent

In a stinging attack on the Scottish Government, Professor Keith Oldroyd, director of research and development at the flagship Golden Jubilee National Hospital in Clydebank, said Scotland lagged years behind the rest of the UK and Europe when it came to introducing new drugs and techniques. As well as a postcode lottery among Scottish regions, he identified a social one where patients with articulate, supportive families who fought for treatment were given it while more isolated and less confident patients were not.

In one case he described as terrible, a patient was given open-heart surgery despite two cardiac surgeons saying he needed the latest, less invasive valve operation only available in England. The patient died after surgery. Professor Oldroyd voiced his criticisms after the health and sport committee of the Scottish Parliament launched its inquiry into access to new medicines in Scotland.Cancer specialists have sent letters to the committee, saying they cannot prescribe drugs which are seen as standard around the world.In England and Wales, health boards are obliged to introduce new treatments approved by the National Institute for Health and Clinical Excellence (Nice) within three months. In Scotland, there is no such requirement. Professor Oldroyd said cardiologists had been waiting for 18 months to start using a drug called ticagrelor, which has been shown to increase the survival chances of heart-attack victims.Although it was approved by the Scottish equivalent of Nice, the Scottish Medicines Consortium, Professor Oldroyd said doctors were told to wait.In the absence of a consensus, NHS Lothian is said to be making the drug available to thousands of patients. But Professor Oldroyd said NHS Greater Glasgow and Clyde has only agreed to its use in a small number of exceptional cases.Professor Oldroyd said: "There is a single reason for this restriction and that is cost containment - It means patients in the west of Scotland are not getting the standard care available in the rest of the UK. This is quite common. We always get these new treatments several years after the rest of the UK."Professor Oldroyd said heart-attack patients in Aberdeen are being treated in line with the latest European recommendations, while in the west of Scotland and Edinburgh they are not.Angioplasties – when a stent is placed in a blocked artery – are seen as one of the best treatments for heart-attack patients.The procedure has to be carried out promptly to minimise heart damage. Most centres in Scotland perform it on patients who reach hospital within 90 minutes of an attack. But two years ago the window was raised to 120 minutes, enabling more people to access the treatment. Again, said Professor Oldroyd, cardiologists were asked to delay the revised time-bar's introduction. Aberdeen Royal Infirmary, however, has acted on the advice.Professor Oldroyd said it would happen eventually but at such a pace that "a lot of patients are suffering and some are dying".Even the introduction of the latest, less invasive form of heart valve surgery in Scotland is unambitious, he said. In a statement, NHS Greater Glasgow and Clyde said: "The criteria by which ticagrelor is prescribed to our patients is based on the advice of the regional West of Scotland Cardiac Prescribing Group (WSCPG)."The WSCPG bases its advice to regional boards on the evidence available on the effectiveness of drugs. However, this is not the only drug currently available and licensed for use in these patient groups."The WSCPG is currently considering further criteria for other patient groups who may also benefit from ticagrelor."A Scottish Government spokesman said: "Tackling heart disease has always been and will remain a priority for the Scottish Government. "We are determined that people who need angioplasty have access to this life-saving procedure. The Scottish Intercollegiate Guidelines Network (Sign) has reviewed its current angioplasty guidance in light of the recently published European guidance and work is under way to consider a formal revision of the guidance in Scotland. This could further extend eligibility for angioplasty and increase access for people who have had a heart attack. The Scottish Government expects that Sign will issue updated guidance shortly. "We are not aware of any systematic evidence to suggest Scottish patients are being disadvantaged in terms of access to devices of proven effectiveness."

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Victims of heart attacks denied life-saving drugs

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