World’s first ‘blackouts’ clinic opens in Manchester
A unique clinic to provide rapid diagnosis and treatment to people with unexplained blackouts has opened at the Manchester Royal Infirmary.
Based in the Manchester Heart Centre, the clinic was pioneered by Dr Adam Fitzpatrick, a cardiologist and heart rhythm specialist. The Rapid Access Blackouts Triage Clinic (RABTC) is run by a multidisciplinary team from cardiology, neurology, and falls. They work together to give all patients a basic, thorough evaluation, so a serious heart condition can be ruled out and appropriate follow-up or specialist treatment given.
Up to 50 percent of the UK population will suffer a blackout at some point during their lifetime. A variety of conditions can cause blackouts, so it can be a long and difficult process to reach an accurate diagnosis.
Blackouts triggered by a heart problem can appear very similar to epileptic seizures. It is estimated that approximately 28 percent of patients currently diagnosed with epilepsy are misdiagnosed (over 125,000 patients in the UK).
A recent All Party Parliamentary Group report on Epilepsy in England found that £189 million was wasted by the NHS on ‘epilepsy’ treatment in the UK each year, when the diagnosis was wrong. It also revealed that life-threatening heart conditions were being missed, and some young patients wrongly diagnosed with epilepsy were dying of sudden cardiac arrest.
“The Rapid Access Blackout Triage Clinic will significantly improve patient care, and there has been much interest in establishing more of these clinics around the UK and Europe,” explained Dr Fitzpatrick.
“Linking several disciplines within one rapid access clinic will attract referrals which might have gone to the wrong specialist in the past. Many patients get “stuck” in the wrong care-pathway, and this is very wasteful in every sense. Other patients have had a life-threatening heart rhythm condition – known as arrhythmia - missed, and epilepsy diagnosed instead. We know of several young people who have died tragically and unnecessarily while taking epilepsy drugs that were never going to save them.
“GPs will feel much more comfortable if they can rely on a thorough evaluation in a triage clinic, which considers and rules out all the possibilities, before requesting appropriate specialist care. Rapid Access Blackouts Clinics were specified by the NHS National Service Framework for Arrhythmias and Sudden Cardiac Death in 2005, but no resources have been made available. Hopefully this latest report from MPs will now help establish more such clinics.”
As well as being a feature of epilepsy, blackouts are also one of the first symptoms of life-threatening arrhythmias, a condition which causes over 100,000 deaths every year. Early diagnosis and treatment is therefore vital, yet there are fewer than 80 dedicated heart rhythm specialists in the whole country – less than one for every 750,000 people.
People with blackouts also often report injuries from their sudden falls, which occur in up to 30 percent of patients older than 65 and cost the NHS about £1 billion every year. Short term consequences such as anxiety, embarrassment and episodes of incontinence during blackouts add to the long-term risk of sudden cardiac death as a result of arrhythmia.
“Rapid access blackout clinics are a vital resource to help improve the accurate diagnosis and treatment of blackouts and arrhythmia” said Trudie Lobban, Chief Executive of STARS, the charity helping people with blackouts. “A wrong diagnosis can have a disruptive effect on people’s lives in addition to preventing access to appropriate treatment for blackouts, which will continue to occur with possible severe consequences.”
Added Dr Fitzpatrick: “The first RABTC in Manchester heralds a new way in which blackouts will be diagnosed and treated, optimising patient care.”