Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, September 23, 2020

Official Report 1055KB pdf

---

Heart Valve Disease Awareness Week

The final item of business is a members’ business debate on motion S5M-22646, in the name of David Stewart, on heart valve disease awareness week. The debate will be concluded without any question being put.

Motion debated,

That the Parliament welcomes Heart Valve Disease Awareness Week, which takes place from 14 to 20 September 2020; notes what it sees as the need to improve early detection of heart valve disease in Scotland; acknowledges the reported increasing prevalence of severe heart valve disease in an ageing population; notes what it considers the missed opportunities to detect the disease during the COVID-19 lockdown restrictions; believes that, in the medium term, this may result in a second wave of deaths from non-COVID-19-related diseases, and notes the calls for more funding to be made available for minimally invasive, proactive and curative treatments, which it considers have a huge advantage of reducing critical care occupancy by shortening the convalescence period and increasing treatment capacity.

18:22  

I thank all colleagues who are joining me in this debate on national heart valve disease awareness week. I would particularly like to thank the hardy band of members still here in the chamber who are joining us for the twilight shift after our machinations earlier on. I am very grateful to every one of them for being here and to all the colleagues who could not attend but have signed my motion, which laid the groundwork for today’s debate on building awareness of the symptoms of heart valve disease and drawing attention to better diagnosis and treatment options for what is a forgotten epidemic.

As members are probably aware, heart valve disease is a debilitating condition that causes functional cardiovascular decline and leads to premature death if left untreated. It is caused, as we all know, by wear, disease or damage to one or more of the valves affecting the flow of blood through the heart. For some people, heart valve disease can progress very slowly with unspecified symptoms. However, if left untreated, it can be serious. Symptoms of heart valve disease include tiredness under exertion, breathlessness and dizziness. As one would probably expect, heart valve disease is more prevalent in older people. Approximately 135,000 Scots over the age of 65 live with moderate or severe heart valve disease.

Despite that, diagnosis is poor and treatment options are limited. Heart valve disease can be detected through a simple stethoscope check. However, nearly 80 per cent of people aged 60 and over report rarely or never being checked with a stethoscope by their general practitioner. The result of that is a reduction in early diagnosis and proactive interventions that can be life saving and more cost effective to the national health service.

Treatment options are often inaccessible for many of those affected by heart valve disease. Only 1,117 valve surgeries were performed on people in Scotland aged over 65 in 2018-19—that is less than 1 per cent of heart valve disease patients. Another treatment, transcatheter aortic valve implementation, avoids the need for high-risk, uncompromising open-heart surgery but is available only in selected Scottish hospitals, such as the Golden Jubilee, the Royal infirmary of Edinburgh and Aberdeen royal infirmary, where access is capped at fewer than 400 procedures per year. In my region, the Highlands and Islands, many constituents have to travel more than 200 miles to get treatment, which exemplifies the inequality in access that marks heart valve disease treatment in Scotland. Perhaps it is a case of geographic inequality. I hope that, during this evening’s discussion with our select band, we can consider that issue, which haunts the broader Scottish health system and which the British Heart Foundation recently identified as one of the critical issues to tackle in its 2021 strategy on heart disease in Scotland.

The issues around diagnosis and treatment have been exacerbated, of course, by the Covid-19 pandemic. Thousands of routine heart check-ups have been missed, and scores of people with the life-threatening condition may still be undiagnosed. Patients, of course, need to trust health professionals to attend their scheduled medical visits and avoid any risk of the disease worsening. As the threat of a second Covid-19 wave approaches us and further health service disruption looms, I hope that we can use this heart valve awareness week as not only an opportunity to provide better diagnoses and equal treatment for people with structural heart diseases but a means of reducing patients’ vulnerability to Covid-19 by delivering timely treatments that can have the advantage of reducing critical care occupancy and providing a safe option through Covid-19.

I would like to pay special thanks to the patient charity Heart Valve Voice for its particular efforts on this debate and its work with the Global Heart Hub and other charities in raising awareness of heart valve disease across the UK. I hope that the debate will help to raise awareness in Scotland of this condition and ensure that our older citizens in particular can access treatment for healthy ageing.

The purpose of the debate is to awareness of the symptoms of heart valve disease, applaud the work that is being carried out by our hard-working NHS staff and the patient charity Heart Valve Voice, and to draw attention to diagnosis and treatment options for this forgotten epidemic. That is a demanding and challenging objective to achieve but, as the renowned Chinese philosopher Lao Tzu said,

“A journey of a thousand miles begins with the first step.”

18:27  

I congratulate Dave Stewart on bringing the debate to the chamber. I apologise to Mr Stewart and other members because I will have to leave after my speech. I am supposed to be chairing an annual general meeting of a cross-party group that started about 20 minutes ago. After today’s business, I am not quite sure whether it is still Wednesday.

Dave Stewart has brought the debate to the chamber to highlight heart valve disease awareness week. It had a really simple ask this year, which was “Listen to your heart”. It urged everybody to ask their doctor for a stethoscope check, which is the first step in diagnosing heart valve disease. As Mr Stewart says, it is a very debilitating condition that causes functional cardiovascular decline and leads to premature death if left untreated. It is caused by wear and tear, disease or damage to one or more of the valves affecting the flow of blood through the heart. I was quite surprised to hear the number of people in Scotland who suffer from heart valve disease: 130,000. It is obviously more prevalent in older people, and that figure is projected to rise to almost 200,000 by 2040, as Scotland’s population ages.

Given the disease’s prevalence, it is surprising to hear that fewer than 1 per cent of the total number of heart valve disease patients in Scotland are treated every year. Only 1,117 surgeries were performed on people aged over 65 in 2018-19. I was also really struck by the barrier, in Scotland’s hospitals, to accessing what is, initially, a minimally invasive therapy that can help with heart valve disease, which has the huge advantage of helping people to avoid the critical care occupancy that Dave Stewart talked about, by shortening the convalescence period. That treatment option can allow patients to leave hospital in a much timelier manner, which makes it safer and more efficient for older patients.

Obviously, we cannot go past this debate without mentioning the dreaded Covid-19, which would seriously impact on the condition. Having the condition or a condition such as obesity or type 2 diabetes, which Mr Stewart and I have a particular interest in, means that a person is more likely to have a poor outcome from Covid-19. It is therefore significant when we talk about the number of people in Scotland who suffer from the condition. Obviously, there is a backlog in heart valve disease diagnosis and treatment while we tackle the Covid pandemic.

The recommendations do not seem to be a big ask. The uptake of stethoscope checks and access to echocardiography for Scottish patients do not seem to me to be a big ask. The fact that there are geographical anomalies in the treatment of unpreventable heart valve disease has been highlighted, and we should look to close them. Access to suitable treatment options, which we have discussed, to enable shorter convalescent periods, assessment of a second wave of mortality from non-Covid-19 diseases, treatment options that reduce the vulnerability to Covid-19, especially for older patients, and ensuring the treatment of treatable heart conditions to allow for healthy ageing have been recommended.

Those recommendations look like very simple ways forward. I talk a lot about preventable conditions and treatments, and this seems to be one of those cases.

Again, I thank David Stewart for bringing the debate to the chamber, and I apologise to members for having to leave early.

That is fine, Mr Whittle. You gave me advance notice of that.

18:32  

I thank David Stewart for bringing a topic that is clearly important to the chamber.

I express sympathy for all those who live with heart valve disease. We are in exceptional times. Covid-19, which has rightly been referred to, is placing stress on the health service and on many people physically and mentally. There is a real risk for people who have serious health conditions such as heart valve disease, and I recognise the struggle that they may be experiencing. I hope that, in the near future, they will be more comforted by the way that things are going.

I am part of the ageing population; I will be 74 in a couple of weeks’ time. For me, the stethoscope test probably does not matter very much, because I have seen a general practitioner only once since I was elected to the Parliament 20 years ago, so a GP has not had the opportunity to put a stethoscope on my chest. I have my fingers crossed that nothing is going on in there that I should be worrying about. However, age is the big risk factor, so perhaps the next time the nurse inoculates me against the flu, I should ask her or him—although they are all female at my practice—to have a listen if possible. For me, there is a bit of self-interest in my interest in the issue.

Age is not the only risk factor; genetics can be a significant factor in predetermining whether people have heart problems of one sort or another. HVD risk factors include lifestyle issues, such as smoking, physical inactivity and being significantly overweight or obese. With a little professional help, we can do something about some of those things at our own hand.

Since lockdown, I have managed to walk 600-plus miles because a bit of time has been created by my not commuting for 12 hours a week between home and the Parliament. I have experienced the health benefits of doing that. Walking is, of course, a cheap, non-medical intervention. Lifestyle is important, and I hope that health professionals will aid people to understand what they can do at their own hand.

However, the stethoscope test is the main thing that we should focus on. It is disturbing to hear that so many people with heart valve disease are undiagnosed. Perhaps people do not notice the slow attrition of their health that comes from it and do not seek the assistance that they should seek as early as possible. It is widely recognised that one of the risks associated with the coronavirus pandemic is that people are a little less eager to see their GP and more likely just to lift the phone and talk to NHS 24. I certainly encourage people to go to their GP and get that stethoscope on their chest, as recommended by the British Heart Foundation. After all, HVD causes 22 per cent of premature deaths.

I agree with David Stewart and the British Heart Foundation about the importance of HVD, I congratulate David Stewart again for bringing the issue to the Parliament and I am grateful for the opportunity to make a small contribution to the debate.

18:36  

I congratulate my colleague David Stewart on securing this debate on the important issue of heart valve disease. I am aware that Mr Stewart will stand down from Parliament next year, so I pay tribute to him for the work that he has done over the past 13 years in bringing such issues to the Parliament in members’ business debates, questions and other interventions.

Heart valve disease and similar issues are practical issues that have an impact on all our constituents. The hard work of MSPs such as Mr Stewart help to bring them to the fore and to the awareness of ministers and the Government in a way that, I hope, ultimately makes a difference to people’s lives.

At the heart of the motion is heart valve disease awareness week and raising awareness of heart disease. As David Stewart said, the issue is clearly a matter of concern for people, particularly older people, in whom heart problems are detected. Such problems can be debilitating and can lead to premature death.

As other members have highlighted, early detection is required to address the issue. However, that can be difficult, because an echocardiogram is required for proper detection. However, Stewart Stevenson highlighted the British Heart Foundation’s point about the stethoscope check, which is easy and practical. The BHF campaign seeks to make people aware of that so that they can follow it up with their GP. People might not automatically link symptoms such as tiredness and lightheadedness to a heart problem, and might think that they have just been slightly overdoing it. However, a stethoscope check might find an issue with their heart. Early detection and proper medication might not cure the problem, but they can slow down the deterioration of the heart and make a big difference to the quality of people’s lives.

In his motion, David Stewart makes a point about the impact of the Covid-19 pandemic, which has understandably caused a massive backlog in normal health checks that would detect some health issues. It is important to emphasise to people that the health service has not closed down, and, to be fair, the Government is doing that. If people have symptoms or concerns, they can contact their GP and follow that up with an appointment to address their concerns.

The British Heart Foundation campaign also makes some reasonable funding demands. There is always sensitivity around funding and demands on budgets, but there are real benefits to be had from the British Heart Foundation’s demands. The campaign is about early detection and slowing down the deterioration of a heart condition. Ultimately, if the condition is detected early and properly medicated, there will be less strain on the health service and those affected will be able to continue to be active.

Dave Stewart has highlighted an important issue that affects a lot of people in Scotland. It is important that we follow up on the campaign’s demands in relation to both early detection, by encouraging people to visit their GP for a proper check-up, and the allocation of funding for proper support, which could make a real difference. I look forward to hearing the minister’s response.

18:41  

I, too, congratulate Dave Stewart on securing the debate and wish him all the best when he steps down from Parliament.

I asked to speak in the debate because I thought that my family experience might be of use. My partner Stuart had emergency open-heart surgery for the condition in the Edinburgh royal infirmary in 2018 at the age of just 52. That shows that it affects younger people as well. His experience is a warning to other people not to ignore symptoms.

For about six months before his hospital admission, Stuart had what he thought was a cold that he could not shake off. He became more and more ill, coughing at night and finding it difficult to sleep, and he was short of breath and tired all the time. I thought that he might have chronic obstructive pulmonary disease or some other kind of lung disease and I nagged him to stop smoking and to see the GP. Eventually, he went to the GP in Dumfries and Galloway who sent him for an X-ray that was inconclusive.

However, just a few weeks later, Stuart was in Edinburgh and found that he could not walk to the shops to buy a pint of milk. It was a weekend and he was on his own, so he went to the accident and emergency department at Edinburgh royal infirmary. The tests showed that he had a bicuspid aortic valve. That is a type of abnormality that some people are born with, so I could not blame smoking in his case, although smoking is linked to many different forms of heart disease.

In a bicuspid aortic valve, the valve has only two small flaps instead of the normal three that most people are born with. It is a really common congenital cardiac abnormality, with a prevalence rate of 1 to 2 per cent of the population, and it is almost three times more common in males than in females.

The condition means that the valve eventually narrows and stops opening fully, which reduces blood flow from the heart to the body. Stuart had emergency open-heart surgery to replace his aortic valve with an artificial one and to repair his mitral valve, which was damaged through trying to compensate for the failed valve. He was later told that he would have had literally days left to live if he had not presented at A and E.

We are hugely grateful for the care that Stuart received from the team at the Edinburgh royal, which was world class. Dr Miles Behan, the cardiologist, and Mr Renzo Pessotto, the surgeon, did a first-class job. As members can imagine, Mr Pessotto is Italian, which further underlines the importance of talented European citizens to our NHS.

Stuart’s experience is why I ask people not to ignore symptoms such as exhaustion, coughing, fluid retention and chest pain, should they occur. As the First Minister said yesterday, despite Covid, the Government’s priority is to ensure that the NHS can and will cope with all conditions.

Stuart stopped smoking in order to ensure that he could cope with the surgery and recover fully and, apart from a few slips, he is still a non-smoker two years later, so the story has a healthy as well as happy ending.

I congratulate David Stewart again on securing the debate and urge everyone who has symptoms to get checked out.

I call Joe FitzPatrick to close for the Government.

18:44  

I am delighted to respond to the debate on behalf of the Government. I thank David Stewart for lodging the motion, and I congratulate him on securing cross-Parliament support for it. I echo James Kelly’s recognition of David Stewart’s long-standing commitment to raising such issues in the chamber. I am not going to wish him the best on his retirement yet, because, knowing him, he will continue to be tenacious in bringing such matters to our attention and—in the gentlest and most constructive of ways—encouraging the Government to look at and work constructively with him and others on them.

I fully agree that, together, we should be instrumental in raising awareness of heart valve disease and the impact of that important condition on people across Scotland. I also agree that the prevention, detection, diagnosis, treatment and management of the condition should be regarded as a priority. That is why heart disease remains a clinical priority for NHS Scotland and the Scottish Government. There has been substantive investment in and redesign of cardiology services, which has contributed to a reduction of more than 32.4 per cent in the mortality rate over the past 10 years.

We are continuing to implement our “Heart Disease Improvement Plan”, which sets out the priorities and actions for delivering improved prevention, diagnosis, treatment and care for people in Scotland who live with or are affected by heart disease, including heart valve disease. The plan identifies a number of priority areas for improvement, on all of which progress has been made. There has been a focus on new ways of encouraging heart disease patients to influence their treatment and an emphasis on specialist heart disease rehabilitation to reduce mortality and long-term disability, as well as on improving the provision of supported self-management, physical activity and services.

However, that is only part of the solution and, as Stewart Stevenson reminded us, the main way to further decrease heart disease lies in lifestyle changes. As Stewart Stevenson said, taking regular exercise, stopping smoking—which Joan McAlpine mentioned—and cutting down on alcohol consumption are some of the steps that we can all take to reduce our risk.

As the Covid crisis has highlighted, reducing health inequalities is one of the biggest challenges that we face; indeed, Covid has undoubtedly exacerbated the situation. That is why, through our programme for government, we have committed to promoting healthier and more active lifestyles for everyone. An ageing population, increasingly complex healthcare needs and more people living with one or more long-term conditions all have the potential to add to the demand on our health and social care services. We know that valvular heart disease remains a significant cause of morbidity and mortality, particularly among elderly patients. David Stewart gave us a good outline of the condition.

As part of our “Heart Disease Improvement Plan”, we have continued to make progress in diagnosis of the condition and delivery of the right treatment and care for people in Scotland who live with or who are affected by valvular heart disease. Joan McAlpine talked about a very invasive open heart surgery, and I am glad to hear that Stuart is doing so well and is keeping off the cigarettes. We have seen growth in the number of treatments that are available for valvular heart disease, many of which are much less invasive than open heart surgery—in fact, they are minimally invasive, as well as being proactive and curative.

For example, the Scottish percutaneous mitral valve and related interventions service in NHS Lothian, which has been fully funded by the national services division for almost three years, offers minimally invasive procedures to correct disorders that affect the mitral valve. That treatment benefits patients who are deemed to be at high operative risk and is preferential to open surgical treatment. As David Stewart told us, TAVI also provides a less invasive alternative to surgical aortic valve replacement in the case of patients who have severe aortic stenosis. There has been some talk about the impact of Covid on some treatments in the NHS, but it is good to note that the TAVI service at the Golden Jubilee national hospital has been maintained throughout the pandemic, with no reduction in the volume of procedures, and has continued to provide excellent outcomes for patients.

However, we know that that has not been the case for all heart disease services during Covid, and we are aware of the impact that it has had on all our lives. Some people have faced the experience of personal ill health, some the loss of a loved one, and everyone has had to deal with the impact of lockdown restrictions and a changed way of living.

Although our knowledge is not complete, we know that the virus can leave long-term physical and psychological consequences for many who contract it. We know that there is an increased risk for people living with chronic heart disease and, in particular, the potential for their cardiac condition to worsen should they contract Covid-19. We also know that there have been excess deaths since the start of the pandemic, not all of which have been related to Covid. The recent publication by Public Health Scotland on the underlying causes of excess deaths in Scotland during the Covid-19 pandemic by area deprivation clearly shows us the impact that Covid has had on those who are living with underlying health conditions. We need to better understand excess deaths during the pandemic, and work is on-going in that area. The Scottish Government, Public Health Scotland and National Records of Scotland are engaged in a programme of research to understand the wider impact of Covid-19 on Scotland’s population.

Although our efforts are currently focused on saving lives, we are also planning how our NHS can move forward after the crisis has passed. Our immediate priority is the remobilisation of NHS work to restart services that were paused due to Covid and tackle the backlog of procedures that was mentioned by Brian Whittle and James Kelly. That work is already under way.

We have begun safely and incrementally resuming services that had been suspended, delayed or deferred due to Covid-19, but the reality is that the coronavirus is likely to be with us for some time to come, and restarting paused services has to be measured against the need to keep the virus under control while continuing to protect the NHS and save lives.

As the pandemic eases, we are following an evidence-based, cautious and phased approach to restarting NHS services, and we are working closely with health boards to minimise delays going forward, supported by the actions that are set out in local remobilisation plans, while also being able to respond to on-going Covid-19 requirements as necessary. It is clear that Covid continues to create pressures on NHS services and affect service delivery, which will undoubtedly have an adverse impact on people living with heart conditions. However, our NHS is well prepared to deal with any second wave of Covid-19, by learning from our experiences over the past few months and building on the new and innovative ways in which services have responded.

Through the refresh of the heart disease improvement plan, we will continue to drive improvements in diagnosis, care, treatment and support, specifically for people living with heart disease, taking into account the legacy of Covid-19. By combining all our efforts, we can make a real difference to those who are living with heart valve disease in Scotland. I look forward to continuing the constructive and productive discussions as we continue to improve heart valve disease outcomes in Scotland. I am confident that tonight’s debate, which was instigated by David Stewart, will help to raise awareness of this very important condition.

Meeting closed at 18:53.