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Thousands of patients are being denied the choice of life-saving heart drugs by cash-strapped NHS trusts.The UK drugs watchdog gave GPs the green light two years ago to prescribe new-generation blood-thinners for people with irregular heartbeats at risk of suffering strokes.
But doctors are defying recommendations from the National Institute for Health and Care Excellence (Nice), according to a leading charity.
The Atrial Fibrillation Association claims that the bodies that deliver NHS treatments are placing restrictions on use of new blood thinner drugs
The Atrial Fibrillation Association (AFA) claims that clinical commissioning groups (CCGs) – the bodies that deliver NHS treatments – are placing restrictions on use of these new drugs.
Jo Jerrome, the charity’s deputy chief executive, said such limits were affecting the quality of life of patients.
She claimed CCGs were driven by a fear that the drugs would be ‘overly expensive and stretch resources’, despite being deemed cost-effective by Nice.
The new blood-thinners – known as novel oral anti-coagulants (NOACs) – cost about £2 a day compared with just £1 a month for warfarin, the most commonly used treatment. But patients on warfarin need regular monitoring which increases the cost of care.
New drug: Novel oral anti-coagulants cost about £2 a day for the NHS
‘We have been told that CCGs are making it extremely difficult such as imposing a nine-month wait before patients are given an alternative drug,’ said Ms Jerrome. ‘Patients have even said they’ve been told wrongly that the drugs haven’t been approved.
‘Trusts in some parts of London have made it difficult by making GPs sign long contracts if they’re going to prescribe these new drugs. This isn’t usual and it limits patient choice.’
One doctor, who asked not to be named, told The Mail on Sunday he had seen evidence of CCGs prohibiting the drugs, and the AFA claims to have reports of doctors being threatened with fines for prescribing them.
On its website, NHS Vale of York CCG warns of ‘cost implications to the NHS’, stating: ‘Significant numbers of patients changing from warfarin to a NOAC would . . . lead to the need to limit commissioning of other services’.
In Oxfordshire, the CCG says ‘warfarin remains the agent of choice for most patients’. It denied it was restricting the use of the new drugs, and said clinicians were using them ‘in line with published Nice guidelines’.
More than a million patients in the UK suffer the most common heart rhythm disorder – known as atrial fibrillation – and the condition is blamed for causing more than 20,000 strokes a year in this country.
The most commonly used therapy is warfarin, which is the same chemical used in high doses to kill vermin. But patients who take this blood-thinner need regular blood tests to prevent them suffering complications.
These checks reveal if their blood is clotting too much, which can trigger a stroke, or clotting too little, which increases the risk of internal bleeding.
Nice gave the go-ahead in 2012 for three new thinners – dabigatran, rivaroxaban and apixaban – that promised to revolutionise stroke-prevention. They are effective yet do not require the same monitoring. However, the UK lags behind the rest of Europe when it comes to prescribing them.
Consultant cardiologist Martin Cowie, from Imperial College London, said doctors were failing patients by denying them choice and it should be ‘automatic’ that people received the new drugs.
Tory MP Glyn Davies, who has undergone treatment for an irregular heartbeat himself, claimed take-up of new treatments had been absolutely ‘abysmal’.
A Nice spokesman said: ‘CCGs are legally obliged to fund these new drugs in cases where they’re clinically appropriate.’
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