15. Short Debate: Heart Failure — Innovation is saving lives

– in the Senedd at 7:01 pm on 31 January 2024.

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Photo of Elin Jones Elin Jones Plaid Cymru 7:01, 31 January 2024

(Translated)

We will move immediately to the short debate.

Photo of Elin Jones Elin Jones Plaid Cymru

If Members could leave quietly—. We still have one debate to hear, and that debate is to be introduced by Sarah Murphy. Sarah Murphy, you can start.

Photo of Sarah Murphy Sarah Murphy Labour

Diolch, Llywydd. I'm really pleased to be able to do this short debate today. If I could have called it 'The rock stars of cardiology are in Bridgend', I would have, but I probably wouldn't have got that past the Table Office, so instead I've gone for 'Heart failure' and looking at the innovation that is happening in the Princess of Wales Hospital in Bridgend.

Just to give a bit of background, I was very, very pleased to go and meet with the cardiology team at Princess of Wales Hospital in Cwm Taf Morgannwg health board. Dr Wong, the consultant cardiologist, and Rhys Williams, who is a specialist clinical pharmacist in cardiology, both showed me around what they've created there, which I truly think is, and many consider, some of the best work that is actually happening in Europe. This is why I just really wanted to show it off tonight.

Just a little bit of background when it comes to how serious heart failure is, and I know this is something that touches many people's lives personally or through loved ones. The national heart failure audit said that the prevalence of heart failure is estimated at 2 per cent of the population, with the Welsh population estimated at 3.3 million by July 2024, and this equates to 66,000 people nationally. The prognosis of severe heart failure is worse than the majority of common cancers, with five-year mortality estimated for around 50 per cent of people. And heart failure hospital admissions account for roughly 2 per cent of the overall NHS budget.

The British Society for Heart Failure has launched the 25in25 campaign, with the aim to reduce heart failure mortality by 25 per cent in the next 25 years, through earlier detection of symptoms, improving population health, and timely access to therapies. I also wanted to point out here that there's a wonderful article on how we end women's health inequality in the Welsh Fabian Society booklet. This was written by Gemma Roberts of the British Heart Foundation. She said that women are also more likely to be diagnosed slowly or misdiagnosed, so women not being seen as at risk of heart attack can impact whether women presenting with heart attack symptoms receive a timely and correct diagnosis.

An incorrect initial diagnosis after a heart attack increases the risk of death after 30 days by 70 per cent. And research suggests that women are 50 per cent more likely than men to receive the wrong initial diagnosis for a heart attack. The British Heart Foundation-funded researchers at the University of Leeds also found that women are referred for diagnostic testing much more slowly than men, and the study found that women who had a type of heart attack usually caused by a partially blocked artery are 34 per cent less likely than men to receive a coronary angiography imaging test within 72 hours of their hospital admission. As you would have seen then, I did turn to my colleague Alun Davies, as I believe that you have had some experience with this, very sadly, and so I would like to take an intervention from you now, so that you may be able to talk to us a little bit about what this can be like for people.

Photo of Alun Davies Alun Davies Labour 7:04, 31 January 2024

I'm grateful to the Member for Bridgend and Porthcawl for bringing this debate this evening. I think it's really important and essential that you've done this, because as one of the 3 per cent of people in Wales who survive an out-of-hospital cardiac arrest, my experience tells me that we need to have a far more holistic approach to heart health, and the ability to spot early, treat early, and, then, work with people to overcome the issues that they faced in their lives. And I hope the Minister, in replying to this debate, will pay tribute to the work that's being done in the Princess of Wales Hospital, but will also look towards a cardiology programme that is more holistic than we have at present, which brings together the prevention and the treatment, and, then, the rehabilitation, to ensure that we have that approach that takes care of people who do suffer these issues in their lifetimes. 

(Translated)

Joyce Watson took the Chair.

Photo of Sarah Murphy Sarah Murphy Labour 7:05, 31 January 2024

Thank you very much, Alun Davies. It brings me on, really, to the next section I want to discuss, which is treatment. Guideline-directed medical therapies, known as the four pillars of treatment, can help to reduce mortality, improve quality of life, and reduce the risk of hospital admission due to breathlessness and fluid retention. And these benefits can be seen as early as 14 days after starting treatment. Better outcomes are associated with higher doses, so require repeated visits. Four-pillar therapy also further reduces the need for other potential costly interventions, including implantation of cardiac devices, ventricular assist devices, and cardiac transplantation. Delays, though, in access to these treatments can have significant consequences for patient outcomes, as mentioned above. 

Looking at the Princess of Wales model, it's been led by Dr Aaron Wong and is a multidisciplinary approach. Heart failure specialist nurses are part of the team. There's a review of hospital in-patients, providing education to patients and carers, and optimising medicines prior to discharge, an ambulatory review of patients who call the heart failure helpline, or management of their symptoms, avoiding likely hospital admissions and emergency department visits. A multidisciplinary team, working with palliative care, provide advance care planning to patients who are within the last 12 months of their life.

And then it brings me on to what I think is quite unique about this programme, which is the collaboration with the pharmacy department. I had another visit where I got to go around the pharmacy department in the Princess of Wales Hospital. I think, up until that point, I didn't realise what a huge thing it is, really, what a huge department it is, how much they do there. And they work tremendously, and I do think to myself sometimes, if I ever stopped being a politician, I'd love to go back and retrain in pharmacy. I just find it absolutely fascinating, and I think that it's so much more than some people realise, and prescribing pharmacy especially. So, the way that we're boosting up those specialist pharmacists, Minister, I think is a tremendous help throughout our NHS. 

What the heart failure pharmacists, like Rhys, are doing is they're providing timely optimisation of the four-pillar therapies—optimisation of cardiovascular risk factors, including diabetes, hypertension and cholesterol. And work from the Bridgend heart failure service has been presented on the European stage. So, again, I just want to say I think that the beauty of this is that Rhys will run his clinic, where people will come in and see him and check their medication and check that they're doing really well, and, then, you've got Dr Wong there who will catch people very quickly when they come in and they present with these issues. He's got the absolute best technology there to do those assessments so much more quickly. They've actually managed to reduce it, I believe, from 12 months down to three months in the Princess of Wales. 

My understanding is, though, that this kind of pilot scheme has been funded—and they usually are, these kind of pilot schemes—by the pharmaceutical companies, and, now, they're in the process of making that business case to the health board, so that it will hopefully get picked up. But I would also like to see this rolled out everywhere. 

So, just to summarise, these are some of the recommendations that are requested from the Welsh Government: for heart failure to become a national priority condition, and, also, for funding to allow the continuation of heart failure outpatient services to treat patients closer to home, preventing hospital admissions and reducing workload for primary care clinicians—I suppose that's much more in line with what you were saying, Alun Davies, that holistic approach—local enhanced services for community pharmacies to screen patients for common comorbidities, including hypertension, diabetes and high cholesterol, and, then, also, to promote and raise awareness of heart failure on a national level, with support from key stakeholders, including the British Society for Heart Failure, Pumping Marvellous—I hadn't actually heard of that one before, but they sound great—the British Heart Foundation, and Cardiomyopathy UK. Thank you very much. Thank you, Minister. 

Photo of Joyce Watson Joyce Watson Labour 7:09, 31 January 2024

I now call on the Minister for Health and Social Services to reply to the debate. Eluned Morgan

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

Diolch yn fawr. Diolch yn fawr, Sarah. Thank you very much for bringing this debate forward. You talked about the rock stars of cardiology in the Princess of Wales Hospital. I was meeting today with the rock stars of orthopaedic day surgery, watching a rather gory knee replacement, but I've no doubt that the way you've described the cardiologists and their innovations is certainly something that would qualify them to be the rock stars of cardiology. So, thank you very much, and thank you for all the interest you're taking on behalf of your constituents. I think developing improvements and innovation in healthcare is a goal we constantly strive for, and I think it's vital to improving the lives of the people of Wales.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 7:10, 31 January 2024

We know that heart diseases have a huge impact on the people of Wales, and one of the points I'm really keen to amplify today, as you noted in the book that you read from, is the fact that so many women in Wales suffer from heart disease. The British Heart Foundation estimate that at least 100,000 women are living with some form of heart disease in Wales today. The most common of these is coronary heart disease, with around 45,000 women in Wales living with this condition, and many will be shocked to hear that it causes twice as many deaths as breast cancer. I'll forever be grateful for the presentation made to me by the British Heart Foundation, which demonstrated that women have a 50 per cent higher chance than men of receiving the wrong initial diagnosis following a heart attack, and this was one of the key factors that made me pursue a new focus on women and health in Wales.

I think it's really important that women's health issues aren't all put into a gynaecological category. Women are so often treated differently when it comes to issues like diagnosing heart disease, and I really think this has to change. We've got a long way to go to correct that problem, but we're now at least on the right path with a new clinical lead for women's health appointed recently. There are multiple types of heart disease, which includes coronary heart disease, resulting in the heart's blood supply being blocked due to fatty substances. Worldwide, this the single biggest killer of women.

Another significant heart disease is heart failure, where the heart is not strong enough to pump blood around the body. Over 1 million people in the UK have heart failure. The number of new cases per year is now similar to the four most common causes of cancer combined. In Wales, there are 38,000 people with diagnosed heart failure, with potentially thousands of people living with it and not knowing that they're living with it. The incidence of heart failure is rising, and it's projected to rise significantly, in part due to our ageing population and as a consequence of improved survival rates for heart attacks. We're all very pleased that Alun is still with us to tell the tale, and he's quite right to point out that, actually, for an out-of-hospital cardiac arrest, the chance of survival is very slim. So, we're all very pleased that you're still with us, Alun. Currently, 80 percent of heart failure is diagnosed in hospital following an admission with symptoms, and reviews of this group have shown that 40 per cent of these people had symptoms in the months prior to admission that could have triggered an earlier assessment in primary care.

Whilst there's naturally a focus on technological advances, I think it's really important to remember the need for societal developments as well. That focus on prevention, on working collaboratively and consistently, I think, is really important to raise awareness, education, messaging to the public—all of that's going to aid people, I think, to deliver and live healthier lifestyles, whilst also being able to correctly and confidently recognise those symptoms on cardiac issues. To help in this prevention space, the Wales cardiovascular network is working with the British Society for Heart Failure on its 25in25 campaign, and that calls for a national quality improvement initiative to reduce deaths by 25 per cent in the next 25 years, and create a community-based approach to early detection of heart failure. Swansea Bay is the first 25in25 fast-track community in the whole of the United Kingdom, so it's not just the Princess of Wales that is doing good work in this space.

In addition to prevention, early, accurate diagnosis is key to improving the outcomes for those at risk of heart failure. It's important that reviews and diagnostics are achieved in a timely manner to support effective treatment. We see good practice of this across Wales, and Swansea Bay has recently won an NHS Wales award for their heart failure pathway in Gorseinon Hospital, providing rapid access for patients at their new heart failure clinic. Clinicians in Wales have also been considering how to optimise the interactions they have with patients as well as the treatments being provided. In recent years, reviews of drug treatment for those experiencing heart failure have resulted in evidence from within clinics of significant benefits, such as the reduction of admissions and signs that we're beginning to see—[Inaudible.]

Other examples of innovation and supportive treatment for patients include Aneurin Bevan, who are developing community heart failure hubs, where patients attend with family and friends for cardiac rehabilitation, and I think this offers really good opportunities for peer-to-peer support and signposting to supportive services, such as counselling and family support groups.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 7:16, 31 January 2024

(Translated)

Another important field to consider is end-of-life care for people who are facing heart failure. End-of-life care for heart failure in Cardiff and Vale board is another service that has won awards. They use a method where the cardiologist and the palliative care consultant work together to manage end-of-life care for patients, and I understand that this service has seen very notable results for patients. Before this service was in place, patients were often admitted as emergencies at least five times in their last year of life, and over 80 per cent would die at hospital. Now, since the establishment of this service, the number of unplanned admissions for patients in their final years of life has fallen from five to two, on average, and the length of stay is far shorter because of the care that is available in the home. As well as this, over 80 per cent of patients now pass away at home in accordance with their wishes, and the response of patients and families has been very positive. The Wales Cardiac Network is working with health boards to adopt this end-of-life service, and work has started at Cwm Taf Morgannwg and Hywel Dda on this.

Swansea bay has developed significant sites for heart failure, including a CardioMEMS site. Here, innovative technology is being applied to place a sensor in the pulmonary artery of the patient that can measure the pressure. This technology can demonstrate heart failure developing in the patient, so this can be detected before symptoms become evident, in order to provide appropriate treatment, improve the quality of life of patients and to prevent unplanned admissions to hospital. Cardiff and Vale health board is also leading research that uses a therapy device to treat a condition called HFPEF—severe heart failure with preserved ejection fraction. This is a condition where the heart's muscle doesn't relax fully, which means that less blood flows into the heart and the cardiac output decreases.

With regard to innovation more widely, health and social services policy officials have been working to redirect policy in terms of innovation in healthcare. The Wales innovation strategy was launched in February of last year, and development work led by the Welsh Government has been ongoing since then, supporting the delivery plan, which includes a specific section on our health and well-being mission commitments. There is a great deal to do, but we can be sure that the NHS in Wales understands the importance of innovation and development in cardiology. I'm very pleased to hear what is happening in the Princess of Wales Hospital. We do want to see clinicians having the opportunity to provide technology and devices that save lives, and for the public to receive the information they need to support everyone in the community.

So, thank you once again to Sarah Murphy for introducing this very important debate, and I congratulate all of those people who are working in this field, particularly those at the Princess of Wales Hospital, who are supporting people in Wales. Thank you very much.

Photo of Joyce Watson Joyce Watson Labour 7:19, 31 January 2024

And that brings today's proceedings to a close.

(Translated)

The meeting ended at 19:19.