Heart rhythm disorders are a major cause of sudden death and disability, but for many sufferers a modern pacemaker or defibrillator can save life and reduce symptoms when implanted by a simple operation.
The Network Device Survey Group, supported by the Department of Health, the British Cardiovascular Society, Medtronic Ltd and individual Cardiac Networks has today made public ( www.devicesurvey.com) the first systematic survey of the National Health Service in England and Wales in respect of its level and equity of cardiac device provision compared to local relative need. The findings pose a major challenge to the NHS. Whilst increasing numbers of patients are benefiting from these high-tech devices, implantation rates in the UK are amongst the lowest in Western Europe and, as this survey reveals, there is evidence of real local inequity of service provision.
No single or simple reason for the low and inequitable provision of these devices emerges from the survey, but evidence is accumulating for several possible culprits. Low awareness of the significance of relevant symptoms amongst patients and general practitioners, insufficient appreciation at general hospital level of which patients stand to benefit from heart devices, and inadequate investment in resources for diagnosis, device procurement and education are all likely to play a part.
Welcoming the report, Professor Roger Boyle, National Clinical Director for Heart Disease and Stroke, commented that Chapter 8 of the Coronary Heart Disease National Service Framework (CHD NSF) for arrhythmias and sudden cardiac death, published in March 2005, had served to focus the attention of patients, clinicians and the cardiac networks on the local provision of implantable devices. He expressed confidence that this national summary report, and the detailed cardiac network reports which underpin it, would assist cardiac networks and those responsible for purchasing health care to achieve progressive improvements in access to cardiac pacemakers, implantable defibrillators and device treatment for advanced heart failure.
Dr Derek Connelly, President of Heart Rhythm UK, also welcomed the work of the survey group. He commented that “there is clearly an urgent need to improve the level of practice in many parts of the UK in order to bring the overall pacemaker implant rate up to the target level and to minimize ‘postcode-prescribing’ of pacemakers”.
'It is so important that studies like this are made available to the
public' said Trudie Lobban founder of Arrhythmia Alliance (The Heart
Rhythm Charity – www.arrhythmiaalliance.org.uk). 'With over one million heart rhythm patients in the UK, and only 64 heart rhythm specialists, it is vital that patients are empowered with as much information as possible to help them when seeking a diagnosis and appropriate treatment.
A National Heart Rhythm Management Devices Taskforce has recently been established by the Department of Health and the Manchester Heart Centre. The taskforce will consider how access rates generally might be improved and help investigate further the reasons underlying the inequity of access.