I THINK MY GP IS GIVING ME WRONG ADVICE - I... - AF Association

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I THINK MY GP IS GIVING ME WRONG ADVICE - I'M WORRIED.

gemini52
gemini52

I have been in AF since August but apart from the discomfort I can function. My GP is keen to prescribe flecanide which she says I will be on for the rest of my life. I have had one successful cardioversion and when I suggested another she just rolled her eyes and seemed quite annoyed that I suggested it. I an on Apixaban and 10mg Bisoprolol. I am flying to the USA in 6 weeks and would really like to be in NSR. Oh and when I asked to be referred to an EP she said what is that! I was to have a tooth out this morning but my dentist wouldn't do it - I'm just confused and not sure what route to go down. Thank you in advance for any advice. Patricia.

24 Replies
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That is not very reassuring for you at all. I thought only a cardiologist could initiate anti-arrhythmic drugs, not a GP. Being on them for life is a bit extreme as there are other therapies which you know more about than your GP seems to!

As for your referral to an EP - can you find out the nearest/best/preferred one in your area either by looking it up on the AFA website and/or ringing the hospital of your choice and asking? NHS referral may take longer than your 6 weeks but a private referral could take only days. Some EP's will see private patients without a GP referral, some won't - I would ring their secretaries and ask.

In your shoes, I would take control, decide which consultant I want to see and do it. Your quality of life can only improve with correct and timely treatment. Best wishes

Finvola
Finvola in reply to Finvola

Forgot to say - I take Apixaban and had a large, potentially awkward tooth taken out without too much bother. My dentist used non-adrenaline anaesthetic, packed the socket with dissolving gauze and put in two stitches. Job done without stopping Apixaban. Did your dentist give a reason or suggest a referral to a consulting practice?

gemini52
gemini52 in reply to Finvola

Hi Finvola. ..we're you in AF when you had the tooth taken out? He said he would use half non adrenalin and have ordinary. Thank you for your replies.

Finvola
Finvola in reply to gemini52

No, I was in NSR on Flecainide. As you probably know, adrenaline can trigger AF, so I always insist on non adrenaline, even though it is less long-lasting. Dentists like to use adrenaline mine said, as it helps to hold the anaesthetic in the tissues and also helps control bleeding.

The special gauze helped with clotting and I was observed for about 20 minutes afterwards. I also timed my Apixaban dose for an hour after the extraction.

PeterWh
PeterWh in reply to Finvola

As important if you are already in persistent af it can exacurbate your AF and / or cause an AF attack with corresponding increase in HR and BP.

Look through backnposts because someone on here was given an adrenaline injection by the dentist and ended up in A&E. she made a formal complaint to area health authority (dental I think) and this was upheld.

PeterWh
PeterWh in reply to gemini52

Don't let them use half and half. Use all NON adrenaline. That's in the guideline new (as is if on warfarin then INR only has to be 4.0 or below to do an extraction. Insist.

Disappointed but not surprised about GP and flecainide.

Believed that GPs cannot decide to prescribe straight off without sanction from an EP or a cardiologist. GPs used to be able to do so.

The fact that she doesn't know what an EP is suggests that she is 20 years behold me the times.

Also flecainide is contradicted with some heart conditions.

Hi Patricia, it's understable that you're worried and confused at the moment if you've been in AF since August but not getting the support and information from your GP that you need. Good to hear you're on Apixaban though as anti-coagulation is of prime importance to anyone with AF who fits the necessary criteria.

Can I suggest you go to the AFA website and read as much as you can there, as there is a wealth of information available, also you will then hopefully be armed with enough knowledge to be able to go back to the GP and ask again for a referral to an EP.

Perhaps it's also worth getting in touch with your dentist and asking them why they would not do the extraction you were booked in for if they didn't explain at the time. It could be for any number of reasons but you will at least have your mind put at rest as to why not.

I hope you feel well enough to enjoy your trip to the US in a few weeks.

All the best, Kate

Agree with Finvola- GPs can only prescribe Flecanide with Secondary care permission and it has to be introduced properly. Insist on referral to wherever you were cardioverted- or a different hospital , if they don't have anyone dealing with arrhythmias at the one you have used before

It may be flecanide is the answer but this shouldn't be the GP's decision first

Won't they cardiovert you if you go to emergency

So, you have been in AF, had a cardioversion, been in NSR taking a large dose of bisoprolol and apixaban, but no flecainide, and then you go into AF and stay there, your GP is now talking about flecainide for life but no cardioversion and now your dentist is standing back and you are off to the States in 6 weeks. I think you are entitled to feel unsettled!

You perhaps need to weigh up short term and long term factors. If you have any referrals or tests or investigations in the pipeline, you will have trouble with travel insurance, so decide whether you want to rock the boat. On the other hand, the less time you spend in AF, the better and getting back to NSR may be the priority. I don't feel too helpful here. Very sorry.

You must tell your insurance company what has happened to date because otherwise your insurance will be invalid even for other situations just in case you need it.

I am assuming that you have reverted to persistent AF? Don't worry about that at all. The vast majority of cardioversions do NOT last. Some only last minutes, some hours, some days, some weeks and only a very few long term and those are unlikely to be cell generated AF. I only lasted 26 hours. The main reason for cardioversions is to help determine the future treatment paths by firstly establishing can the patient be returned to NSR and importantly do they feel better in NSR.

Bearing in mind your timescales the only realistic route is to spend £150 to £250 seeing an EP of your choice privately. You should get 30 to 45 minutes consultation which will be invaluable. You may be able to get initial treatment and tests on NHS but it is also you may be even to pay for them the privately because of timescales.

Make sure that your selected EP holds their private clinic and also the private hospital where they do the tests and procedures and where they do their NHS consultations and procedures are convenient for you since sometimes they can be 50 plus miles apart and not easy to travel.

Let us all know how you get on.

Thank you all so much - I think my plan is to visit an EP privately. I was wondering if anyone has flown long distance whilst in persistent AF as perhaps I should wait until I come back from the States. I am going to phone my surgery tomorrow and get an appointment with one of the other GPs for a second opinion.

PeterWh
PeterWh in reply to gemini52

Unfortunately most GPs do not have much experience or knowledge re AF and arrhythmia especially up to date. Even many leading EPs aren't 109% in agreement. My own GP admitted to a student shadowing her that I know more about AF then she does!!! Many newly qualified doctors know more about it than GPs with 25 years experience.

Just go straight to get an EP appointment next week. Apart from anything else that will be very much more acceptable to your insurance company. If you don't your insurance company may very well refuse cover if you travel because they almost certainly will not accept GP's assessment (or an assessment by two GPs).

If you travel without telling your insurance company you have developed persistent AF and that you haven't seen a consultant nor had tests then it's 88% certain you are not covered. USA is a very expensive place to pick up the medical cost tabs. Unlike the mugs we are in the UK they won't treat unless confirmation provided by insurance company and / or your credit card. I think some heart attack and emergency life saving may be covered for 24 hours on some hospitals.

traveler65
traveler65 in reply to PeterWh

@PeterWh why don't people traveling buy emergency medical insurance as well as emergency evacuation (for medical or other) insurance? This insurance will pay your medical bills up to quite a large amount--such as $259,000. It is necessary to find the company that pays the hospital or doctor as you are there , rather than reimbursing you after you pay. Also available to travelers is an organization called IAMAT ( International association of medical assistance to travelers)-- you join on line at no cost and receive a membership card with a member ID number- you are now in their data base. You also receive a booklet listing doctors in alphabetical order by country and within each country by city. When you travel you can use any of these doctors for $50 at the office fee and $150 if they come to your hotel. They are all western trained modern level doctors, the ones used by people in foreign countries such as those working in embassies or for large companies doing work there etc.

Hidden
Hidden

Rolling eyes, forget it! Change your GP maybe or at least insist on a referral to an EP. My GP also asked what an EP was, and when I said Electrophysiologist, but he didn't know what that was. I described my EP as a Heart Rhythm Specialist after that, which seemed to oil the wheels a bit.

Pay for a private consultation if you need to, roughly £200-250? I paid £150 about 4 years ago. Flecainide didn't work on me, made me worse, then EP tried another drug, then another. Eventually the fourth worked well without apparent side-effects. EP did all that over a 2-3 week period.

My GP can't prescribe rhythmn control drugs.

Koll

gemini52
gemini52 in reply to Hidden

Thank you...It's so good to get input from fellow sufferers. I am definitely going to get an EP appointment. Patricia.

traveler65
traveler65 in reply to gemini52

@geminui52 SEE an EP. They are the only ones who know about afib., the effects and problems with all the different drugs and relating to your specific genetics, other conditions you have etc., and also the only ones who know how to interpret an ekg of a person with afib.

PeterWh
PeterWh in reply to traveler65

To get the link to work you need to type in the name and then either select with the mouse or hit the return key (which won't insert a new line!!!

seasider18
seasider18 in reply to Hidden

One GP thought that my pacemaker should have cured my AF.

tibetan36
tibetan36 in reply to seasider18

What the heck! Sack your GP.

you need ECG's when starting Flec, it can cause problems with long Qt syndrome amongst other things.

My GP is useless with AF and refers everything to the EP

Get rid of GP. But before you do ask for a referral to an Electrophysiologist. I cannot believe a GP would not know who a EP is. Do it asap as this GP is playing around with your life. 😊

PeterWh
PeterWh in reply to tibetan36

I can because unless they have finished their training in the last 10 years EPs basically did not exist!!!

GPs can often give wrong advice or no advice. As soon as you suspect this, seek a second opinion. Then a third if necessary. No harm in visiting more than one GP.

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