AF Association

Can GPs' manage PAF

I was admitted to A and E last November with AF and stabilised with drugs over the next 3 days, Sotalol and Abixaban.

Then discharged with a echogram and 24 monitor to follow. Saw my EP later who said alls well and discharged me back to GP.

Blood pressure climbed for some odd reason and given Ramapril gradually upto maximum dose, but now have appalling tiredness which I don't know if its the Sotalol or Ramapril.

So made an appointment for GP but unsure if they normally manage AF. Most on here seem to be with their EP.

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GPs are not always fully informed about AF. They do their best but under NICE guidelines should refer you to a specialist if they are unable to control your symptoms. As we keep saying here sotalol is not a recommended drug for AF these days but some EPs still use it. Many drugs used in treating AF can cause symptoms worse than the AF so you are not alone there.

As far as I am aware GPs do not normally prescribe anti-arrhythmic drugs without approval of consultant level .

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Hi shortfall, I could have written that as you have had the same experience as me. Diagnosed last August , got appointment for echo and 48 hour monitor, all OK just one 20 second episode recorded and condition of heart A1, Reffered to my Gp , never saw a cardiolagist let alone an E p it was all done by letter, had 3 episodes since then so 3/4 month gaps , chads score 2 because I'm female and age , no co morbitities, fit as a butchers dog ! ( just come in from a 7 mile walk ) iv been given riveraxiban but don't need anything else as pulse rate naturally slow, do I feel like iv been shoved out the door, you bet I do, like you I have so many questions but apart from this forum no help at all fromthe professionals just a shut up and get on with it attitude, I sincerly hope you have better luck than me, keep in touch I'd be interested to know how you get on, good luck . Moreen

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Hi Moreen, I initially got excellent help I have to say, the hospital was beyond reproach. Just amazed to be referred back to GP. I expected say a six month or yearly check with EP but I suppose they are in short supply and concentrate on the urgent.

My GP is good, when I can see him (6 weeks for none emergency appointment) but I worry about changing meds.

You seem to have had a rough ride but sound quite fit so thats a positive.

I agree, lots of questions and this wonderful forum is my saviour.

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It is for me too, what the people on this forum seem to give you is a lot of confidence because at the beginning it is very scary. Its a lonely place when your first diagnosed but this forum has helped me so much, Moreen.

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@BobD Sotalol and the NICE recommendations, is it not recommended for cost reasons or clinical reasons?

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nothing to do with cost but the possible side effect of the rare torsades de pointes ventricular arrrythmia that sotalol can induce (but other beta blockers don't)

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Read the pros and cons for any drug on Medscape, pubmed, drugs.com or any site that gives this information. Stay away from drugs as long as you can.

I keep recommending chiropractic care but few if anyone listens. Bucking the common care approach is never easily accepted or encouraged. Unfortunately, not all chiropractors have the same skill set so this too can be a bit of a crap shoot. In fact most don't know that they can impact AF and are likely restricted from saying that they can. You will need to tell them what they need to do. This is not a one visit solution. It can take many visits over several months. When I get time I will post my experience to date which has been positive after several tries with different chiropractors. I know chiropractic care works for some people; so, to me, I thought an alternative of no drugs or surgery seemed like a sensible one to explore, especially when qualified EP's or others are not readily accessible. I thought I might as well try something else in the interim. I tried diet, exercise and supplements with minimal positive results and the drugs I tried made my AF worse, which they can do.

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Whilst I respect your views EngMac and use a chiropractor myself, I would point out that the healthcare system in Canada is very different to that in UK.

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Hi - I think you make some very good points regarding follow-ups and information and ask a very pertinent question.

I was very lucky with my GP when I was originally diagnosed over 10 years ago as he was extremely well informed about heart matters, it had been his special interest. He referred me locally to Cardiology who were basically, not of any help - prescribing aspirin and Sotolol, the aspirin I took and the Sotolol I refused. After many letters back and forth between GP and Cardiologist - we settled on me taking Flecainide as as PIP ( pill in the the pocket). He was my rock at that stage and went above and beyond and fought my corner with the local Cardiology department who wrote me off as a trouble maker.

Fast track to 2013 - I attended my first patient day of the AFA. I learned more in one day than I had in the previous 6 years. Within 2 weeks I had a referral to an EP, unfortunately there was none in the area I lived so I had to travel to London and I had to go privately. He recommended ablation and within a few more weeks I had my first ablation. That seemed to upset the local cardiologist somewhat and I then had a few unfortunate encounters before returning to the London EP for a second ablation which gave me nearly 3 years AF free.

I currently have some AF episodes but none are of the severity or are as symptomatic as the earlier ones, or as yet! I am well aware they could progress. I take only anti-coagulants. I cannot take any anti-Arrythmic drugs nor any heart rate drug because of another condition. After anti-coagulants all treatment are purely for quality of life - they will not cure AF, they will not prolong your life and they can often have side effects which at best can make you feel rotten all the time, instead of only when AF strikes. Over long periods they may have undesired affects as all these drugs are toxic so it will always be a risk:benefit ratio analysis as to what treatment to take.

I have rambled a bit but my point is that expertise varies, some GPs are excellent managers of AF - if they are well informed. The only way you will know is if YOU are well informed. Question your GP on the use of Sotolol and point out that it is no longer recommended by NICE for treatment of lone AF and watch the reaction.

My advice would be to read as much as you can and then attend the AFA patient day where you will have direct access to the top expertise in the country on AF and its' management.

Unfortunately not every area is well served with EPs and those areas that are, are under huge demand so you are correct that there is no systematic monitoring of AF, mainly because on the hospital pecking order - it figures fairly low - because it is not considered in the lingo 'white shroud' material i.e. - immediately life threatening.

Find out if there is a support group in your area and Arrythmia nurse. If there area, become well acquainted and you should then have some direct access. Same applies to EP secretaries.

If you need a consultation, it can be very worth while getting a private consultation, it won't affect any NHS treatments but you will buy yourself time to talk to the EP without the time pressures in clinic. Cost circa £150-250 + costs of tests.

Knowledge is power and unfortunately any chronic condition also requires a degree of patient expertise and self-management, I have experience of at least 3 so find this is a general experience - the more you know - the more proactive you can be - the more informed questions you ask - the more seriously you will be taken. Sad - but true.

Best wishes CD.

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Many thanks for your comprehensive reply CD, much appreciated and much to consider.

Regards John

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I've lived in 2 different area's and had 3 GP's since having AF. From my experiences I am surpised GP dealing with. All of them have not wanted to do anything without say so from consultant. As you have had changes since the EP said all is well I would ask to be referred back. As with all things it is pot luck who you get and how well its dealt with. Stay strong and ask for what you need.

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Thank you kate444

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I think all even the very best GP's do is manage the condition. Even cardiologists can be happy just putting you on drugs for blood clots, blood pressure, etc. If you feel good and the afib isn't impacting your life, that can be ok. It seems like to really get someone to actively treat afib, versus just manage the conditon, you meed to see an electro cardiology specialist. I felt very let down by my GP and Cardiologist (my cardiologist is one of the most respected in the area too) at their willingess to do very little for my afib. I didn't really get much information on long-term health issues, and as long as I wasn't acute in their minds - they didn't seem too fussed by my lower quality of life and medication side effects. But that is just my expirence.

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Thanks Amydandy, its seems my suspicion may be correct in that you need to be in an acute state to get some attention from the right source..

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Or make a lot of noise, politely of course!

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I would also add that the situation has now changed and our local hospital now has 2 EP doctors who fight our corner very well, ably assisted by 2 excellent Arrythmia Nurses who organise local support group.

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