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Health: Cardiology

Volume 743: debated on Wednesday 6 March 2013


Asked By

To ask Her Majesty’s Government what measures they are taking to detect and prevent sudden cardiac death.

My Lords, as the Cardiovascular Disease Outcomes Strategy published yesterday made clear, the national clinical director for heart disease will continue to work with all relevant stakeholders to develop and spread good practice in this area. Alongside this, the UK National Screening Committee is reviewing the case for screening for sudden cardiac death, and will begin a public consultation on this soon.

I thank my noble friend the Minister for that Answer. He will no doubt be aware that hundreds of young people die as a result of fatal premature cardiac conditions each year. He may also have heard of the Oliver King Foundation, established in memory of a 12 year-old Liverpool boy who sadly died of sudden death syndrome at his school in 2011. Does the Minister not agree that despite many ambulance trusts having some form of community resuscitation department, it should be policy to install automated external defibrillators in all public buildings? Furthermore, will the Minister agree to meet with the foundation and others to discuss the feasibility of a national screening programme to identify those at risk and prevent further loss of life, particularly among young people?

My Lords, I pay tribute to the Oliver King Foundation for its work, as indeed I do to Cardiac Risk in the Young, which for many years has been campaigning very tellingly and successfully in this area. I think that my initial Answer should have satisfied my noble friend on the screening question, because that is now being reviewed by the screening committee. Regarding defibrillators, we have to look at the need to improve survival rates in the most effective way. I understand that the majority of these deaths—possibly as many as 80%—occur in the home. While we agree that the wider availability of defibrillators could save additional lives, CPR skills—cardiopulmonary resuscitation—should save more lives. To that end, the outcomes strategy says that my department will work with the Resuscitation Council, the British Heart Foundation and others to increase the number of people who are trained in CPR.

My Lords, will the noble Earl encourage all schools to incorporate training in CPR for all schoolchildren? A skill learnt there will carry on through the rest of a child’s life.

My Lords, the noble Lord makes a very good point. Again, as the CVD outcomes strategy sets out, basic life-support skills could be more widely taught as part of volunteering programmes; for example, in schools and the workplace. I am aware that bystander CPR doubles survival rates yet is attempted in only 20% to 30% of cases. There is scope for all emergency service personnel to be trained in CPR, and for basic life-support skills to be taught more widely.

Are departmental advisers working with the new chief coroner, whose appointment has been widely welcomed, to ensure that there are minimum standards at post-mortem, so that when a young person has had a sudden cardiac death the risk to other family members can be appropriately identified? It is important that specimens from the heart of a deceased young person are not lost because the post-mortem has not been done to a high enough standard.

The noble Baroness makes a very important point. My department supported the formation of the UK Cardiac Pathology Network in 2006 to provide local coroners with an expert cardiac pathology service and to promote best pathological practice in sudden death cases. A national database on sudden arrhythmic death was launched in November 2008, allowing pathologists to record information on cases referred to them. In the longer term this could be very helpful in building a deeper understanding of the problem.

My Lords, during 2011, 56 deaths were caused by fire in London. Legislation requires all public buildings to have fire extinguishers. In that same period in London, there were 9,657 out-of-hospital cardiac arrests. Why is there no similar legislation for public-access defibrillators?

My Lords, as a general point, ambulance trusts are by far the best placed to understand the requirements of their local populations in terms of defibrillator distribution. However, I understand that the British Heart Foundation is looking into the need for more defibrillators in the community, so we will await that work with great interest.

My Lords, can my noble friend tell us what effect in percentage terms obesity is having, particularly on the young? I read that a considerable percentage of deaths and heart problems are due to obesity. What programmes do we have running to reduce the level of obesity in the United Kingdom?

My Lords, a variety of programmes is running, including Change4Life and the national screening programme. However, as my noble friend will be aware, the kind of sudden cardiac death mentioned in the Question is rather different from cardiovascular disease, which afflicts people in later life. We are talking in the Question about unexplained, very sudden cardiac death in the young, which we believe has little to do with lifestyles and much more to do with genetic susceptibility.

My Lords, will the Minister explain a little bit more about the proposed public consultation on screening? The evidence for the screening of families where a cardiac death has occurred, particularly in a young person—which is linked to a gene—is conclusive, so what is the public consultation about?

The public consultation is reviewing the policy position on screening for hypertrophic cardiomyopathy, but the noble Lord is absolutely right that better identification of families who are at high risk of inherited cardiac conditions is vital. That is stressed in the cardiovascular strategy.