Atrial Fibrillation Screening – APCC Managing Director Responds to NSC Consultation Document

Dear National Screening Committee

Re: Screening for Atrial Fibrillation in Adults

I have studied with considerable care your consultation document on the subject of Atrial Fibrillation (AF) in the adult population of the United Kingdom. In consequence, I am writing to urge you to reconsider your position and to approve screening for the aforementioned group.

It almost goes without saying that the presence of a simple test in the diagnostics used by NHS staff and other professionals, to screen patients who are showing symptoms of AF is potentially of great importance; to patient, doctor and the health service as a whole.  The absence of such screening will, in many cases, result in serious consequences that will be damaging to health and wellbeing of patients and, by extension, their families, so often the bearers of the burdens of long-term care where catastrophic malfunction has occurred. An assertion based in fact is that patients suffering from Atrial Fibrillation are at a massively increased risk of suffering an AF-related stroke, heart failure, dementia and even sudden death.

The cost to the NHS of screening, when compared to the cost of managing the treatment of patients who suffer AF related stroke or heart failure, or are diagnosed with likely AF related dementia, would be the most cost-effective strategy, and this strikingly obvious preventative measure is surely signposted as the way forward. An example of prevention at its most effective, in both cost and human terms, is acting immediately on a screening outcome by the prescription of anticoagulant therapy. It is a valid assertion that 75% of those suffering the symptons of Atrial Fibrillation will avoid AF related stroke. The cost of non-screening will continue to adversely impact NHS budgets, preventing the saving and reallocation of potentially billions of pounds.

The statistic that should make even the most cynical amongst us take notice is that 33% of patients who are diagnosed at an early stage with AF are less likely to die suddenly. Once again, the critical importance of screening is obvious.

The United Kingdom, thanks mainly to its outstanding health service, has an increasingly aged population.  With this in mind, figures have shown that Atrial Fibrillation occurs in the following:

  • 10% of people over the age of 70 years
  • 20% over the age of 80 years
  • 50% over the age of 100 years

The ease of diagnosis and subsequent management of the condition is imperative to saving lives and money.

The condition can be detected by a simple pulse check and/or mobile ECG.  Using anticoagulation therapy, the patient will, in a high proportion of cases, be protected.  An irregular heart rhythm can be treated with a number of options, the detail of which doesn’t require expansion here. With the pointers highlighted by screening, the patients are, more often than not, able to return to an active work and social life, and be able to manage their condition with little assistance from the NHS.

I have read in the consultation document the assertion that an ECG is not hazard free and could lead to over-investigation.  Surely, if an ECG shows an abnormality, the patient should be investigated in order to diagnose and treat any further complications before those complications manifest themselves in a more serious and potentially long-term medical condition, putting further strain on the NHS.

I have in all sincerity attempted an diligent study of the consultation document, but am at a complete and utter loss to understand the rationale the National Screening Committee has used to arrive at the conclusion that a simple screening process would be an unacceptable commitment to a preventative measure that could revolutionise diagnosis and treatment of Atrial Fibrillation. Whilst on the subject of statistics, it should be noted by the National Screening Committee that at least 500,000 people in England alone live with the condition.

The recent publication of the Long Term Plan by Public Health England (PHE) has a target for increasing detection of AF to 84% by 2029.  This will be impossible to achieve if the screening is not approved by the National Screening Committee.

The NHSE, in its constant endeavours to reduce costs through greater efficiencies, wish to detect far more potential AF-related stroke cases.  Once again, the application of relatively simple detection techniques beg to be approved and adopted.

I urge you to reconsider your decision and embrace AF screening. It would be one of the most logical and potentially beneficial practices to be adopted within the NHS.

Yours faithfully

Stephen Law-Lyons

Managing Director

APC Cardiovascular ltd