Just joined.

[Tracyt]

I was diagnosed in October with AF and AFL. I had my medication played with due to episodes and thought it was finally being managed. Am on 10mg Bisoprolol, but this last few days have been feeling awful again, is this normal? Looks lie am back to the doctor tomorrow!

[BobD Volunteer]

The bisoprolol will just make you feel like death at that dose. Try to get to see a proper heart rhythm specialist (EP--_Electrophysiologist) and discuss options for your treatment. What age are you are are you on anticoagulants?

Bob

[Tracyt in reply to BobD]

I was feeling fine on it. They had to up my dose when I started having heart flutters as well. It's only the last few days that my symptoms have returned. Am 48 and not on anything else. Apparently it goes on a point system for blood thinners and I don't have any!

[PeterWh]

I was told and I have read on this post forum that it doesn't matter about the points score. If you have AF you should be on anticoagulants. Ian or Bob can comment further

[BobD Volunteer]

Sorry Peter I do get tired of keep bashing on about anticoagulation. There are a great number of specialists and patients who believe that if you have AF then you should be on anticoagulation. Period. BUT as a specialist at HRC last year told us, if he did that then he would save quite a few people from stroke but also kill a few from bleeds. The Chadsvasc system is a pointer but only a guide and whilst personally I score low I have been on warfarin out of choice for ten years. AF after all makes us five times more likely to have a stroke without any additional risks form Chads etc. I am now of an age when it WOULD have been indicated anyway. One also has to balance stroke risk against bleed risk with the HASBLED chart as well. You really wouldn't put an alcoholic on warfarin for example, not if you wanted them to survive. I wish it was as simple as AF- give anticoagulants but in UK it isn't. One must point out, however, that we are very bad at this in UK . We have one of the lowest percentage of at risk patients on anticoagulation in Europe and it has been calculated that we could save 8000 strokes a year if we changed that. The saving to NHS would be enormous and far out weigh the cost of the anticoagulation. I firmly believe that we patients should be driving this by demanding to be so treated where appropriate.

Bob

[PeterWh in reply to BobD]

Bob. Should have replied sooner. Apologies if I was not clear above. My point was, from what I have been told and what I have heard, is that even if CHADs = 0 if you have AF then you should be on anticoagulation unless there were other circumstances which put you at greater risk (eg as you said an alcoholic). My score was 0 and my GP said straight away that I had to go onto anticoagulants because I had AF. The only delay (6 days) was because she wanted the consultant EP to decide which of the NOACs was the most appropriate in my case.

[BobD Volunteer in reply to PeterWh]

I do so agree with you Peter but sadly NHS as yet do not and tend to rely overly on CHADSVASC etc. There is the usual post code lottery added to which many GPs are scared witless of anticoagulation. You may have been one of the lucky ones with an enlightened GP but there are far too many who should be on it but are not. There is available a Patient Decision Aid which explains both CHADS and Hasbled in great detail and is supposed to be given to all patients considering anticoagulation by the doctor prior to any decision. This was released mid year 2014 but I doubt anybody has seen one apart from me who proof read it. LOL CAREAF website may have it.

Great discussion by the way.

Bob

[paulh1]

As Bob says you really need to weigh the advantages versus disadvantages. Friend of mine ,about my age, had a skiing accident while on anticoagulants.A snow boarder ran into him. Brain injury . Doctors had a tough time stemming the bleeding. They had to remove a portion of his skull. The point is, here was an incident that just happened out of the blue. For me, it's worth the risk taking them

[pip_pip in reply to paulh1]

Hmmmm...

[MickN]

I have spoken with a guy local who has been persistent AF for four years (as had four ablations) he has been on dronedarone for that time and takes no anticoagulant which I was amazed at, his EP and GP are happy enough by all accounts.