Mike Freelander (Macarthur, Australian Labor Party) Share this | Link to this | Hansard source

I move:

That this House:

(1) acknowledges the outstanding work of hearts4hearts and its CEO Ms Tanya Hall in promoting awareness and improved treatment of cardiac arrhythmias;

(2) notes that:

(a) atrial fibrillation affects at least 500,000 Australians and comes with high risk of stroke and heart failure with conventional treatments;

(b) while many cardiovascular conditions have declined in mortality rates in the past years, the mortality rates for atrial fibrillation have almost doubled in the last two decades;

(c) catheter ablation is the acknowledged best practice treatment;

(d) there are long waiting lists for catheter ablation in the public hospital system and the treatment is not listed on the Prostheses List; and

(e) up to 40,000 Australians could benefit from catheter ablation, including 13,000 on private health insurance; and

(3) welcomes the recent announcement by the Minister for Health that the Government will consider changes to Prostheses List processes in order to account for catheter ablation and other non implantable devices, but calls on the Minister to provide further details on this announcement, including a clear time line for implementation.

I rise today to speak on this motion brought by me and seconded by the member for Bennelong, Mr John Alexander, for which I am very grateful. This motion asks the Minister for Health to urgently allow the catheter required for catheter ablation of atrial fibrillation to be listed on the Prostheses List so that it can be rebated and made available for use in private hospitals. As mentioned in the motion, atrial fibrillation affects at least half a million Australians. There can be underlying causes such as congenital heart disease or thyroid disease but overwhelmingly the cause is cardiovascular disease, and the risk of developing atrial fibrillation increases with age.

The effects of atrial fibrillation can be very, very debilitating. Many in this chamber may suffer from atrial fibrillation as they get older, and they may require treatment. It can be very debilitating, particularly in older people. What happens is that the two top pumping chambers of the heart that contract and pump blood to the two bottom chambers don't contract properly because of the multiple electrical stimulation of the heart muscle, so it fibrillates—it vibrates rather than pumps—and this can lead to increasing problems such as heart failure. There is also a high risk of sudden death or embolic stroke from atrial fibrillation, as well as other morbidities, including the requirement for frequent hospitalisation, severe anxiety, loss of work, right-heart failure with oedema and the inability to exercise. As I have already mentioned, it can become much worse as people age.

Atrial fibrillation occurs when there are areas of heart damage in the two atria, as I've mentioned. Until recently, treatment has focused on either electrical cardioversion, where an electric shock is given to the heart while someone is sedated to try and stop the heart beating in the hope that it will return to normal beating function as the shock wears off, or treatment using medication, such as antiarrhythmic medications, often combined with anticoagulants, or blood-thinning medications, such as warfarin. The newer accepted best practice for treatment of atrial fibrillation is the use of a catheter to ablate, either by freezing or burning, the little areas in the atria that cause the frequent electrical stimulation. This is accepted worldwide as best practice, and is now performed in public hospitals many thousands of times every year.

However, the catheter required for catheter ablation of atrial fibrillation is not listed on the Prostheses List; it is not implantable—it is not seen as an implantable device. It is a removable device, and is therefore not listed on the Prostheses List and cannot be rebated by private health funds when it is used in a private hospital. This may leave private patients many thousands of dollars out of pocket. It is an area of active discrimination against people who have private health insurance. At this time, when the minister is looking at ways of trying to improve the efficiency of private health insurance and the Australian people's demand for it, this is one area where he could act immediately to provide world's best practice for private patients. I urge him to do so.

This is a little bit personal for me. My own father had atrial fibrillation and was treated with warfarin, an anticoagulant. Unfortunately, because there is often difficulty controlling the dose, he had a haemorrhagic stroke which left him physically disabled for the last 10 years of his life—although, thankfully, not cognitively disabled. This is clearly an area of discrimination against people who have private insurance, and I urge the minister to act as soon as possible to improve this. I thank the member for Bennelong for seconding my motion. I also thank the other speakers: Maria Vamvakinou, the member for Calwell; Michelle Landry, the member for Capricornia; Tony Zappia— (Time expired)

Brian Mitchell (Lyons, Australian Labor Party) Share this | Link to this | Hansard source

Is the motion seconded?

Michelle Landry (Capricornia, National Party) Share this | Link to this | Hansard source

I second the motion. As co-convener, with the member for Calwell, of the Parliamentary Friends of the Heart Foundation and Stroke Foundation I have been proud to work with hearts4heart and its CEO, Tanya Hall, to increase awareness of atrial fibrillation. Ms Hall is a passionate advocate and a survivor of this condition. Through the work of hearts4heart she has made great headway with targeted educational programs and services to assist patients, medical professionals and policymakers to ensure early diagnosis and treatment of heart disease. In particular, the Time to change the beat white paper identifies strategies to improve the detection and management of atrial fibrillation.

Heart disease, and in particular atrial fibrillation, is a growing risk both to peoples' health and the national budget in Australia. I am sure most people in this place have personal experience with cardiac conditions and, particularly, atrial fibrillation. Whether it is oneself or a relative, a friend or work colleague, we are all touched at some stage by the fallout heart disease can create. Atrial fibrillation, or AF, is a type of abnormal heart rhythm. It starts in the upper chambers of your heart and causes them to quiver instead of beating normally. This can mean your heart doesn't pump blood around your body as efficiently as it should. AF is associated with up to a sevenfold increase in the risk of stroke, a threefold increase in the risk of heart failure and double the risk of subsequent death. That is seriously scary stuff. Perhaps the scariest thing about AF is that many patients are unaware of their condition. For 25 per cent of people who have an AF-related stroke, the stroke is the first sign that they have it. The prevalence of AF is expected to double in the next decade, placing greater strain on our health system. The annual cost of AF equates to approximately $5,200 per annum for each person with AF, which is more than the per capita cost of osteoarthritis, obesity or cardiovascular disease.

Catheter ablation has emerged as an alternative to medical management for selected patients, particularly when medical management is ineffective. The provision of catheter-based AF ablation services in Australia has increased exponentially since early this century. Studies have shown that most patients who are arrhythmia free one year after ablation remain arrhythmia free five years after ablation. Eliminating AF through catheter ablation would also reduce AF-related stroke, heart attack and poor health risks. Avoidance of an AF-related stroke is likely to save the Australian healthcare system at least $30,000 per patient for the first year.

Despite the positive statistics, we have seen reluctance from health funds to cover catheter ablations due to a technicality that just doesn't pass the common sense test. It is a fundamental of a civilised society that one can access good treatment for one's ailments. Should this particular treatment be included in private health insurance lists, it promises to both cure patients and provide a benefit to the taxpayer by keeping private patients private, not clogging up the public system. The news just last week that we, as a government, will review the listing of new targeted medical devices, like catheter ablations, is a positive step forward, and one I hope will see the procedure accepted by health insurers. I will continue to work with Minister Hunt to see outcomes improve for those with heart conditions like atrial fibrillation. Thank you.

Maria Vamvakinou (Calwell, Australian Labor Party) Share this | Link to this | Hansard source

I too rise to speak on the very important private members' motion put forward today by the member for Macarthur in regards to atrial fibrillation. I want to thank him and the member for Bennelong for bringing this very important issue to the attention of the House. I would like to acknowledge the hard work and effort by the hearts4heart foundation on this very important health issue, and I want to also recognise the outstanding contribution of its CEO and founder Ms Tanya Hall, who has worked tirelessly to raise awareness about what is a very serious health condition for Australians.

As the co-chair of the Parliamentary Friends of Heart and Stroke Foundations, I have had the privilege of co-hosting a number of events here at Parliament House with my colleague, the member for Capricornia. I want to thank her for her contribution here today as well. Our group co-hosts events that allow this parliament to be informed on heart and stroke issues and to educate members and senators about preventive measures and about recent innovations in this area. One such event I was honoured to host as the co-chair of this friendship group was the Feel the Beat breakfast, which we had here at Parliament House on 5 September. The aim of the breakfast was to raise awareness of the growing epidemic of atrial fibrillation and to highlight the importance of improved screening, diagnosis and treatment for those affected by arrhythmias, and in this case, of course, we're talking about catheter ablation. The strong attendance at this breakfast—which did include the Minister for Health, the Minister for Education and Training, the shadow Assistant Treasurer, the shadow parliamentary secretary for health and many other colleagues, members and senators—highlighted to me just how important this issue is to each parliamentary colleague and their constituencies.

On that day, the CEO of hearts4heart, Tanya Hall, launched the white paper into atrial fibrillation, and everyone who attended the breakfast had the opportunity to attend a free heart screening test. I undertook that screening, as did my other colleagues. I'm happy to say that I got a very good report. It was all good, so I have a very minor chance—I understand you, Deputy Speaker Mitchell, took the test as well. You're one per cent, and I'm 0.8 per cent, so we're on a good ticket. We have a very minimal chance of developing heart arrhythmias for the time being. However, many Australians aren't so lucky and may not have the access to preventative screenings such as we did, and they may not be lucky enough to have healthy and strong hearts. Therefore, they may be vulnerable to all sorts of heart disease.

Prior to the Feel the Beat event, I had the opportunity to meet with Tanya Hall and talk about the challenges that she faced in her journey as a sufferer of AF. She talked about the pain of living with heart disease and the way in which it severely impacted her life and hindered many aspects of her life and activities. She also described to me, with great passion and conviction, the live-saving catheter ablation procedure, which has changed her life fundamentally. This innovative, non-invasive procedure has allowed Tanya to live a rich and full life and one that she has, to her credit, now devoted to advocating for AF and to fighting for the rights of patients who are currently suffering from this disease.

Atrial fibrillation is a major public health issue. It is one of those issues that require the immediate attention not only of this parliament but also of the government. AF affects at least half a million Australians, and associated with it is a very high risk of stroke and heart failure. Some 30 per cent of AF sufferers remain undiagnosed, and the conventional treatment that is currently available is not as effective as the alternative. Up to 40,000 Australians have the potential of leading fuller and healthier lives through best practice treatment, and that best practice treatment is catheter ablation. Yet, as we have heard, catheter ablation does not fit the criteria of the Prostheses List, and patients often have to wait up to two years to receive this life-saving treatment. Attention from government on this issue is imperative. It must happen, and it must happen now.

John Alexander (Bennelong, Liberal Party) Share this | Link to this | Hansard source

I thank previous speakers for their important contributions to this debate. This is an important issue and I have been very happy to be working on it across the aisle with the members for Macarthur and Calwell and with my colleague the member for Capricornia. Atrial fibrillation is a leading cause of stroke and heart failure for hundreds of thousands of people across Australia. It is a deeply concerning condition that is on the minds of many of our fellow Australians.

Atrial fibrillation is a serious heart rhythm condition which affects the heart's ability to pump blood. In many cases there are no symptoms; however, it is strongly linked with heart failure, dementia and stroke. Indeed, it causes 6,000 strokes and over 60,000 hospitalisations annually. It affects over 460,000 Australians and has no simple or easy solution. In some cases, however, it can be effectively managed by a procedure called catheter ablation, whereby small catheters are temporarily introduced into the affected heart tissue to correct electrical short circuits, which allows the heart to pump blood properly again. Up to 40,000 Australians could benefit from this procedure, which has a strong success rate of 75 per cent. However, too few Australians are receiving this treatment and far too many are suffering and dying unnecessarily.

Under current legislation, health funds are not required to cover patients for medical technology that is not listed on the federal Prostheses List. As the catheter is not implanted in the body permanently but is removed after correcting the heart's fault, it does not fit the criteria of the Prostheses List. Therefore, many sufferers are priced out of receiving this important treatment or are forced to join public hospital waiting lists of one or two years, during which time they are extremely vulnerable. This is an antiquated approach to classifying life-saving medical technology, which must be amended. For the past 10 years, cardiologists, industry and non-profit bodies such as hearts4heart have been advocating for this change, but it has come to no effect. The problem has been going on for too long and it needs to be rectified now. People are dying and having strokes as a result of this not being rectified.

When one day, hopefully soon, the federal government includes catheter ablation on part C of the prostheses list, it will require private insurers to cover the cost of the device for eligible policyholders. This will make 18,500 privately insured sufferers eligible for lifesaving treatment—a substantial increase from the status quo. This reform will drastically improve the lives of those who have suffered for far too long and will save countless lives. The old adage that prevention is better than cure couldn't be more true. Including catheter ablation on the prostheses list is not only financially feasible but also rational from a cost-benefit perspective. We welcome the minister's announcement over the weekend regarding health insurance premiums and the agreement with the Medical Technology Association of Australia. It is certainly important to keep costs as low as possible for families across the country but it is also essential that private health care is an attractive option with full options for conditions, especially for a condition that affects so many Australians.

I commend the minister for announcing the review of additional technologies that could appear on the prostheses list, including catheter ablation. But I would also like clarification on the timing. Even if this discussion takes only a few years, thousands of lives will be irrevocably changed because of this delay. I would also like to take the opportunity to praise the extraordinary work of hearts4heart, and in particular Tanya Hall, who as the CEO and founder of the group has been instrumental in raising awareness about this and other important heart related issues. I have met with Ms Hall on several occasions and she has been an exceptional advocate. I congratulate her for all her efforts so far and I look forward to seeing her continue to have a strong impact in our community in bringing this critical reform across the line.

To conclude, we have before us a policy reform that could save lives and deliver better financial outcomes for the healthcare system. The reasons to adopt this policy are clear, detailed and compelling. I trust that the minister will agree and deliver much-needed support to sufferers of atrial fibrillation in the near future.

Tony Zappia (Makin, Australian Labor Party, Shadow Parliamentary Secretary for Manufacturing) Share this | Link to this | Hansard source

Firstly, I commend the member for Macarthur for bringing this matter of catheter ablation to the attention of the House. I also commend all the other speakers who have spoken in support of the motion. It has bipartisan support, and that is good to see. As other members have already pointed out, atrial fibrillation is a serious heart rhythm condition. And as others have also pointed out, it affects almost 500,000 Australians. Even worse, it costs the healthcare system about $1.6 billion each year in direct healthcare costs. So, if there's no other reason for doing this, it should be done because it will end up being a budget savings for the government.

The reality is that a person with atrial fibrillation, or AF, has five times the risk of suffering a stroke and three times the risk of suffering heart failure. Just as concerning is that in most cases there are no symptoms, there are no warning signs and therefore there are no preventative actions that might otherwise have been taken. In other words, it can come most unexpectedly upon a person and can very quickly either end their life or cause them to have a stroke, indeed changing their life forever. Not surprisingly, over the last 20 years there has been almost a doubling of death rates arising from AF. The risk factors when symptoms are there are similar to all the other risk factors that people with other cardiac conditions have. Physical inactivity, smoking, being overweight, diabetes, high cholesterol and other factors like these all contribute to the risk. Additionally, if someone has those risks—again, similar to those for other cardio conditions—then high blood pressure, dizziness, chest pain and palpitations should be immediate warning signs to go and get yourself checked out.

The good thing about AF is that the test for it is relatively simple. As other members have already said, some testing was done here at Parliament House. I participated in that test. It was, again, a very simple test which gave me some indication of the level of risk I would be at. Equally, other people should be going in to see their GP and having that test. It should be made accessible and available to people wherever they live. If someone is found to be at risk in any way, the good thing is that there is a relatively modern, minimally invasive treatment that is now available. It is that referred to by the speakers, known as catheter ablation. Unfortunately, the procedure is not listed on the federal Prostheses List and therefore not covered for privately insured patients. My understanding is that some 40,000 people in Australia right now would possibly benefit from catheter ablation, of which nearly half are privately insured but can't get any insurance cover and therefore are quite likely to not take up the procedure available to them. If they go on a public hospital waiting list then they might be waiting one or two years. Sadly, for some people that might simply be too long.

Again, it simply doesn't make sense that we have a problem, we have some simple solutions now available, but because of a bureaucratic process, people cannot access those solutions. It is time that the Prostheses List procedure and process was changed. It needs to be changed because we have a clear example of where what might have been a process that was appropriate at the time it was written up is no longer appropriate today. Therefore I certainly welcome the comments from the government speakers that this may happen, but it needs to happen ASAP. Cardiovascular disease remains Australia's biggest killer. I understand that the figures, if anything, are starting to rise again, possibly because of the sedentary lifestyle that so many people live today. It appears that what was once a disease that we were making some progress with is again on the rise. This is one part of cardiovascular disease where progress has been made, where solutions are available and where people can be treated safely, with a 75 per cent success rate, and we ought to get on with it as quickly as possible.

Ian Goodenough (Moore, Liberal Party) Share this | Link to this | Hansard source

The time allotted for this debate has expired. The debate is adjourned. The resumption of the debate will be made an order of the day for the next sitting.