Key treatment delay for Scots heart patients
HUNDREDS of Scots with suspected serious heart problems are being forced to wait more than two months for a potentially life-saving test that should be conducted immediately, it was claimed last night.
A shortage of cardiologists in several areas of Scotland means a growing number of patients are waiting longer than the recommended target of eight weeks for an angiography.
Pressure groups say the situation is unacceptable as most European countries provide the test without patients having to wait at all.
Official figures show the number of people waiting more than eight weeks for an angiography has risen by almost 60% over the past year. The executive’s own limit is 12 weeks, but this will be reduced by four weeks by the end of the year.
Heart conditions cost the lives of 12,000 Scots each year, making it the country’s biggest killer.
An angiography is carried out to show precisely how clogged specific arteries are in and around the heart. Severe cases can require emergency surgery to save the patient’s life.
The 2,000-a-treatment procedure involves injecting a special dye, the movement of which can be detected by X-ray.
According to Scottish Executive figures, in June 2004, 1,474 Scots were waiting for the tests, a 10% rise compared with the number in June 2003. But the number waiting longer than the maximum recommended eight weeks stood at 193, a 58% increase compared with the previous year.
The worst area of Scotland for long waits for an angiography is the Scottish Borders, where 28% of patients must wait at least eight weeks, while patients in the Lothian Health Board area and Dumfries and Galloway are the next worst off, with 19% having to wait more than two months. The next poorest area is Lanarkshire where the figure is 18% of patients.
The best-performing areas of Scotland are Forth Valley, Grampian, Greater Glasgow, and Tayside, where fewer than one patient in 10 must wait for longer than eight weeks. Tayside is the swiftest area of all, with 95% receiving an angiography within two months.
The statistics are likely to be disturbing for Andy Kerr, the new Scottish health minister, because the government has promised that by the end of the year no one will be forced to wait longer than eight weeks.
Against a background of growing delays, and with little prospect of recruiting large numbers of extra cardiologists in the next two months, it is difficult to see how Kerr can deliver on that promise.
In 2001, there were no vacant cardiac consultants’ posts in Scotland’s hospitals. But the latest figures show that five out of a total of 50 are unfilled, all of them for at least six months.
Dr Stuart Shaw, the president of the Scottish Cardiac Society, said: "In the rest of Western Europe the norm is that there should be no wait at all for an angiography, and over eight weeks is simply far too long. For something as serious as a heart problem, delay is never a good option and by the time it is clear that a person needs an angiography their condition is already giving cause for concern.
"The situation places doctors in the extremely difficult position of having to decide whose condition is so acute that their wait must be kept to a minimum. And that means that a decision has to be taken that some patients have to be told they will wait longer."
He added: "The sad fact is that in Scotland we are lagging behind England, while they are going ahead with a 47% increase in the amount of cardiologists and opening 19 new treatment centres.
"We are not seeing the evidence of all the money which is supposed to be being spent on the health service."
David Davidson, the Scottish Tory health spokesman, said: "The doctor is absolutely right. Our cardiac services are lagging behind and it is not going to get much better for a good while.
"There are not enough newly trained cardiologists coming through. The Executive is simply failing to get to grips with the crisis."
A spokeswoman for the British Medical Association, which represents the UK doctors, said: "Tackling heart disease is a priority for Scotland. This requires a commitment to resources, people, equipment and time. Certain fields of medicine are desperately short of consultants, and measures must be taken to retain and attract doctors into these specialities."
But the Scottish Executive last night insisted cardiac care north of the Border was improving.
The overall death rate from coronary heart disease in Scotland has fallen by 2.8% since 2002, from 154.8 to 150.4 per 100,000 people.
Kerr said: "We entirely reject the picture that’s been painted here. Waiting times for heart treatment is a success story in Scotland."
However, the Executive’s critics counter that the growing wait for angiographies shows that those already suffering from advanced heart disease are getting worse treatment.
HELPING TO SAVE A LIFE
CORONARY angiography is an X-ray examination of the blood vessels or chambers of the heart in order to find out the condition of the heart and the surrounding arteries.
An angiography is carried out to show precisely how clogged specific arteries are in and around the heart. They are carried out on people who have already been complaining for some time of chest pains, who may have angina, or who have already undergone tests for possible heart disease.
A very small tube (catheter) is inserted into a blood vessel in the patient’s groin or arm. The tip of the tube is positioned either in the heart or at the beginning of the arteries supplying the heart, and a special fluid (called a contrast medium or dye) is injected. This fluid is visible by X-ray, and the pictures that are obtained are called angiograms.
In recent decades, radiologists, cardiologists and vascular surgeons have used the X-ray angiography procedure to guide minimally invasive surgery of the blood vessels and arteries of the heart. In addition, diagnostic vascular images can often be made using MRI scanning machines, CT scans or ultrasound.
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