Screening for atrial fibrillation is un-evidenced and driven by company NHS England has licenced to foster industry opportunities

There is no reliable evidence to support the West Yorkshire and Harrogate Sustainablity and Transformation Plan (now Integrated Care System)  proposal to centralise hyper acute stroke services. ck999 has already pointed this out to both the West Yorkshire and Harrogate STP Joint Health Scrutiny Committee  and to the West Yorkshire and Harrogate STP Joint Clinical Commissioning Committee.

Now we’ve realised West Yorkshire and Harrogate Integrated Care System has an equally un-evidenced plan to detect and treat 89% of patients with Atrial Fibrillation, based on an estimate by the Yorkshire and Humber Academic Health Science Network that this could prevent up to 190 strokes in the next 3 years and save over £2.5m.

The November 2017 meeting of West Yorkshire and Harrogate STP/ICS Joint Clinical Commissioning Committee agreed to:

“Consider and support the proposal to request each West Yorkshire and Harrogate CCG to: agree an aspiration to detect and treat 89% of patients with Atrial Fibrillation; and work collaboratively with the Yorkshire and Humber Academic Health Science Network on implementing a targeted and phased approach to working with their local practices…”

The West Yorkshire and Harrogate STP/ICS Joint Clinical Commissioning Committee’s “Improving Stroke Outcomes” paper continues:

“The Yorkshire and Humber Academic Health Science Network (Y&H AHSN) have estimated this could result in over 190 strokes being prevented in the next 3 years contributing to a reduction in both the health and well-being gap and the care and quality gap for the population of West Yorkshire and Harrogate.

Y&H AHSN have indicated this level of prevention could save over £2.5m which will contribute to our collective finance and efficiency gap. Although this work may have an impact on local prescribing costs the AHSN have confirmed they will work directly with each CCG to work through the practical aspects of implementation.”

Where’s the evidence to support this? There is none

There is no reliable evidence underpinning the Yorkshire and Humber Academic Health Science Network claim that population screening for atrial fibrillation could result in the prevention of over 190 strokes in the next 3 years.

Oxford University’s Nuffield Department of Primary Care Health Sciences recently announced a trial involving 120,000 patients to investigate whether atrial fibrillation screening for stroke prevention is effective and cost effective. Because at the moment, no one knows.

UK National Screening Committee says atrial fibrillation population screening is not recommended

Update September 2019: A BMJ editorial (BMJ 2019;366:l5311 doi: 10.1136/bmj.l5311) states that the evidence does not support the introduction of screening for atrial fibrillation and other cardiac conditions. It cites the Public Health England Legacy Screening report on the UK National Screening Committee’s recommendation on Atrial Fibrillation screening in adults. The recommendation is:

“Systematic population screening programme not recommended”

The reasons are

  • The review found that it is not clear if the different types of Atrial Fibrillation have the same risk for stroke or how well treatment works in people with Atrial Fibrillation found through screening.
  • The evidence review also found it was uncertain whether screening is better than the current approach.
  • The SAFER trial (led by Cambridge University with £3m funding from the National Institute for Health Research) is starting to try to find out if screening is more effective than the current situation for people with Atrial Fibrillation. This will help the UK NSC understand more about the benefits and harms of screening. (Oddly, the SAFER trial doesn’t seem to be aware of West Yorkshire and Harrogate Integrated Care Systems’s proposal for population screening for Atrial Fibrillation.)

The National Screening Committee’s 2019 review and recommendation confirms and updates GP Margaret McCartney’s British Medical Journal article  on population screening for atrial fibrillation. She said this was not recommended by the UK National Screening Committee in their 2014 review, because of a

“paucity of evidence” about whether “screening asymptomatic people brought the same benefits as diagnosis in symptomatic groups”.

Margaret McCartney’s article also notes that despite the lack of evidence of any benefit:

“There’s a push to screen more people, through the Academic Health Science Networks (one of whose aims is ‘fostering opportunities for industry’)”.

Maybe we should rename the Academic Health Science Network the Crystal Ball Life Sciences Corporate Profiteering Network?

Follow the money

Look where the Yorkshire and Humber Academic Health Science Network is driving NHS money – to the manufacturers of  drugs that are prescribed for patients with atrial fibrillation. As the West Yorkshire and Harrogate STP/ICS Joint Clinical Commissioning Committee “Improving Stroke Outcomes” paper stated

“this work may have an impact on local prescribing costs…”

You bet.

A company licensed by NHS England to drive Life Sciences innovation in the region, the Yorkshire and Humber Academic Health Science Network increasingly has fingers in more and more West Yorkshire and Harrogate Integrated Care System pies.

One of these pies is Standardising Elective Care (with the aim of cutting elective treatments by 10% this financial year,  to cut £50m spending/year.

At the March 2018 West Yorkshire & Harrogate Sustainability and Transformation Partnership Joint Clinical Commissioners meeting, Matt Walsh (Calderdale Clinical Commissioning Group Chief Officer and West Yorkshire and Harrogate Integrated Care System lead for standardising elective care) said that West Yorkshire and Harrogate STP was building an:

“interesting and exciting relationship with behavioural science experts”

from the Yorkshire and Humber Academic Health Sciences Network.

The aim is:

“to change the relationship between people and organisations”

Again, it is corporations that benefit – not patients

Patient behaviour change programmes open up huge Life Sciences business opportunities, based  on patient data harvesting  – patients are becoming a source of profit for life sciences and digitech companies.

We are now in the era of the facebook model of health care – people using the service have their data mined for corporate profit. As is made clear in the Ernst and Young Progressions 2018 report with the rather sinister title “When the human body is the biggest data platform, who will capture value?”

And in the recent Darzi/IPPR report.

And May’s speech about the promised £20bn extra NHS funding by 2023.

But for all the profiteering hype, claims about smart/personalised medicine have little foundation in evidence, as Hilary Rose and Steven Rose report in “Genes, Cells and Brains – The Promethean Promises of the New Biology.”

Dutch Tulips, anyone?

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