Could 30,000 deaths a year be prevented?

Published on Tuesday 8 March 2005 00:14

Key points

• Warning over health risk to blood clots is highlighted

• NHS criticised over underestimation of dangers

• Those who have recently undergone surgery at high risk

Key quote

"Hospital staff and medics are simply not aware of the extent of VTE. Considering the sheer numbers of people who die from the condition I find it shocking that this has been allowed to go unchecked for so long" - David Hinchliffe, Labour MP

Story in full

A SILENT killer claims the lives of more than 30,000 people every year, a damning new report reveals today.

An investigation by MPs has warned that the NHS is systematically and dangerously underestimating the threat from blood-clotting, leading to many unnecessary deaths every year.

Venous Thromboembolism (VTE) is a bigger killer than breast cancer, HIV/AIDS and traffic accidents combined, the Health Select Committee of the House of Commons reports today. In all, some 10 per cent of all deaths in hospital may be down to the condition.

"Hospitals are failing to implement sufficient safeguards to prevent patients from developing VTE," the committee concludes, warning that plans to introduce new guidelines to ward against the condition are too little, too late.

While the danger of bloodclots brought about by long airline flights - so-called deep-vein thrombosis - is relatively well understood, few people realise the danger from the generic form of the condition.

The most common cause of death from the condition is when a clot forms on the wall of a blood vessel, then breaks off and passes through the bloodstream. Should such a clot reach the lung, there is a 30 per cent of death.

The risk is particularly acute among those who have recently had surgery and been discharged, but the committee finds that hospitals do not take account of that risk.

A preventative treatment, thromboprophylaxis, is cheaply and easily available, but is not widely administered, the report concludes.

The most authoritative guidelines devised for anticipating the threat of VTE were devised by Scottish medics, but the MPs found that across the UK, there are disturbing disparities in how well such guidelines are observed.

Every hospital in the UK should set up a "thrombosis committee" to co-ordinate efforts to tackle clotting and raise the awareness of medical staff, the MPs recommend.

"Hospital staff and medics are simply not aware of the extent of VTE," said David Hinchliffe, the Labour MP who chairs the Commons committee. "Considering the sheer numbers of people who die from the condition I find it shocking that this has been allowed to go unchecked for so long."

The root cause of the high death toll is the health service’s under-statement of the threat from VTE.

Part of the problem is the under-reporting of the condition, caused by the fall in the number of post mortem examinations being carried out. Dissection is often the only way to detect that a bloodclot was the cause of death.

But the MPs warn that recent legal cases and scandals over the unauthorised harvesting of organs left made doctors reluctant to carry out autopsies, instead recording the cause of death as more obvious conditions like heart failure.

The number of post-mortem examinations carried out in Scotland has dropped by a third in the past five years, figures released last month showed.

A spokesman for Quality Improvement Scotland, which has responsibility for standards of care in NHS Scotland, insisted that action to tackle the problem is well in hand.

The Scottish Inter-collegiate Guidelines Network, which oversees NHS practice, issued guidelines for detecting and treating bloodclots in October 2002,

"The issue of VTE has been widely recognised by Scottish clinicians and detailed evidence because best practice guidelines were adopted in October 2002, " said the spokesman. "Evidence-based guidelines such as these is an area in which Scotland leads the way."

But Mr Hinchliffe said his committee was equally unimpressed with responses to the problem on both sides of the Border. "Our conclusions should also apply equally in Scotland," he told The Scotsman last night.

The Conservatives seized on the report as a means to attack Labour’s record on the NHS, arguing that it demonstrated that increased spending on the service is not being matched by increases in care.

"Urgent action is required to stop as many preventable deaths as possible," said Chris Grayling, the shadow health minister.

"The government is spending huge amounts on the NHS, but patients are not getting the treatments they need," he added. "It’s about time they stopped spending money on bureaucracy and instead prioritised spending on things we really need."

The family of a Scottish student who died after developing deep vein thrombosis (DVT) yesterday said guidelines on the condition could have prevented their daughter's death.

Katie McPherson, 23, told doctors on three separate occasions that she was suffering from DVT. But doctors put the pain in Ms McPherson’s left calf down to a muscle tear.

Speaking just weeks after the second anniversary of Katie's death, her parents, Gordon and Jane McPherson, agreed that guidelines were needed.

"We feel very strongly there should be guidelines laid down to ensure everybody gets the same treatment. If that had been the case with Katie, she would still be alive, said Mrs McPherson.

"This could happen to anybody and the diagnosis to begin with is not there and neither is the treatment."

A separate medical study yesterday underlined the need for the NHS to take greater account of the threat from clots.

A survey of 63,000 people by the REACH research project yesterday found that the NHS largely ignores atherothrombosis, where blood clots combine with narrowed arteries to cause heart attacks and strokes.