I was set off thinking on this track by various posts/replies where responses have not seemed completely appropriate once the full picture emerged. For instance, if I complained I had been refused a second ablation (I haven't, but not been encouraged) 'considering your age' I know what the reaction from my kind and knowledgeable AFA friends would be! But if I added that there are complications because of asthma, GERD and bad reaction to anaesthetic, spinal fusion (requires dose of heavy duty antibiotic during procedure), possible SSS developing etc some of you might say I should think hard about it because my body is 'old' in some ways and maybe I should save the risks for essential operations such as my hip replacement 🤕
So I'm thinking that doctors, who are supposed to have the whole picture, might be using 'age' as shorthand for 'your body is in bad shape'. On the other hand it could just be agism or covert rationing......What do you think?
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Buffafly
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Hi Buffafly I don't think Doctors are allowed to discriminate on the grounds of age alone although it can be a contributory factor to decision making along with a patients circumstances and comorbidities.
If I was considering having an ablation for AF I know that any comorbidities and some factors like being overweight, drinking too much alcohol, failing to take any exercise, eating a bad diet would make a successful ablation less likely and put me more at risk of complications and I would expect any cardiologist to tell me so preferably without any waffle . It may be something some people do not wish to hear.
I’ve just looked up my EP’s first report and at our discussion about progression of AF in the absence of other factors, he cited ageing as the most common reason for progression.
Regarding ablation, when I asked, his words read ‘I certainly wouldn’t rush into it at her age’. (I was then 72. He agreed, though to offer ablation if my symptoms deteriorated.). I wasn’t offended in the slightest as I know he meant that the risks possibly outweighed any further benefit in QOL. Flecainide was controlling things and I had no AF.
In my case, I don’t think my physical health age was a factor and he was considering my chronological age and the possible need for a repeat. The centre at that time used only RF with general anaesthetic, so the GA added to the possible risks.
I agree there are cases where date of birth seems to trigger negativity but it’s scorn and/or disdain that identify the ageism and that would get my hackles up.
My very pleasant cardiologist used the words 'considering your age' which shook me for a moment as I hadn't thought of my age (73) as being a factor but a bit of thought about my situation made see his point of view.
That’s an interesting one - my understanding is that the doctors must consider and advise according to your best interests overall - and consider all factors. Age may = fraility and therefor increased risk factors for one person but bear no significance for another of the same chronological age.
Benefit v risk always needs to be carefully evaluated - but with and in discussion with the patient as long as considered competent.
I think the real problem is there are many good doctors out there who have difficulty communicating.
My sons’ grandfather-in law was offered a pacemaker aged 101 - having been declared incompetent with dementia - the cardiologist caught him in a moment of competence and he signed the consent form - against the wishes of his family who would not have agreed - had they been informed. He died a few weeks later.
I think it is a very difficult and complex issue but Bob is correct - age should not in itself come into the conversation as a reason for not considering treatment options.
Buffafly.
I've recently had an experience of pure agism. In early Nov 2017 i was diagnosed at a regular eye check with a cataract which needed attention. My GP then referred me on into the NHS system. In early january I was first seen by a hospital based consultant. on 16 March 2018 I was referred for a pre op assessment. Then it all died. Nothing, - zilch - and nobody could answer my queries as to when I'd have surgery.
Late May I made a formal complaint to my MP about the local hospital trust - and only then did I get a surgery date, which is this coming Monday, 2 July.
I made a formal complaint on the grounds of age discrimination ( I am 73, work 30 hours plus a week driving a shuttle bus for which I need a clean medical record of which eyesight is an integral part - part of the requirement for holding a PCV (Bus) drivers licence).
If it weren't for my complaint citing such grounds I'd still meet with this wall of silence.
My point is that increasingly, so long as a person is reasonably fit today's 70's are yesteryear's 50's !
How dare this bl--y health service have such a mindset that says oh ! he/she doesn't matter, he/she is in his/her 70's - he/she can wait. No way, just no way should anybody tolerate this.
I might add what gave the impetus to this complaint was the Daily Mail page 1 headline that based on a FOI request it seems that over 67% of hospital trusts are arbitrarily, without reason or logic, abandoning cateract surgery. MY hospital trust is one of the worst performing in Britain. (Of course there is a reason - money. Save money and to hell with the 'oldies'.
Memo to Jeremy Hunt - mess with this boy at your peril !
On a slightly different tack but related, those of us postponing an ablation offered would I think be wise to use the time to improve physicality so better able to deal with an ablation in the future should QOL demand it.
May I ask why you are postponing your ablation? I am on the lengthy waiting list for one,and actually hoping it is later rather than sooner,as I am trying hard to lose weight ,and am exercising much more to try to get as good a result as possible.
Several reasons: 70% success rate quoted did not sound good enough, MH at the time was not strong, did not know enough about the risks, just thought the 'procedure' was somewhat barbaric in nature and being optimistic felt I should wait for improvements and until I had tried my own lifestyle changes, seen a Naturopath and whether Flecainide would work. I was fortunate as I went from 9 episodes a month to zero on 200mgs Flec/day with no side effects or other drugs (I have Lone PAF & no the comorbidities) and the changes I have made to date just make me feel better and better - but I am now hoisted by my own petard as QOL is so good I dare not rock the boat - yet, by weaning myself slowly off the Flec! Good luck.
Thats my feeling too! 70% seems a bit lacklustre,I too have recently pushed to get Flecanaide down from 200 mg a day to 100,and reduced statins from 80 mg a day to 40.
Feel more in control of my own destiny,weight management top priority,and exercise..swimming 4 times a week,diet,magnesium....lets see how we do??
Dr Gupta says AF is a symptom of a body out of sync.......
Thank you Wilsond, if you are taking statins I would look at taking CoQ10, I am pretty sure I read Statins reduce your CoQ10 levels, in any case Mg & CoQ10 (200mgs/day from a quality supplier) was what my Naturopath put me straighten for AF. It is supposed to strengthen the heart plus a lot of other stuff in the body.
Thanks I will go to our local health store and try this.I think I lost some self belief and confidence when diagnosed with AF,and a suspected TIA,and kind of went along with everything,but now am coming back to my normal self!
Hi secondtry that is exactly what I am doing. I resolved last year to get to a BMI of 25 and am almost there. I have made many lifestyle changes so if an ablation becomes necessary I will be in good shape. I read the 'LEGACY' study at the time and was impressed by the idea that lifestyle changes could decrease the P-AF burden and may halt its progress.
I was offered an ablation in May and have deferred my decision for a year partly because my quality of life is good, my P-AF is under control and I see no good reason to risk a procedure at this time which isn't a cure which could make my QOL worse.
Also they have only just started doing ablations at my local hospital and hope to do a certain number in the first year but if the procedure fails it can't be repeated there, it must be done at another hospital over 100 miles away.
The young doctor I saw at the clinic (the cardiologists assistant) didn't seem at all interested in what was best or 'me 'or the lifestyle changes, I got the impression whatever my age or condition (I am 68) he would have offered me an ablation to 'make up the numbers' so they can say they have done x number in the first year. Hopefully, in a years time the team will be more experienced and my P-AF will not have progressed. I appreciate for some AFers and ablation is better 'sooner rather than later' before remodelling takes place but if lifestyle changes can halt the process I don't see there is much to lose with a delay.
Absolutely, rather cynically and possibly unfairly I wonder if some EPs offer ablations too early without listening to patients' QOL, as they know there is a better chance of another success on their record if they strike early and they have nothing to loose.
A key issue is that AF must be controlled as if not it leads to ever increasing episodes, not often mentioned but I suspect equally relevant is that the longer you go without an episode the less AF you will have in the future!
Have had quite the opposite experience. Told I was much too young to put up with the AF - 69 in a couple of weeks and at my age I should definitely go with the ablation option!! My Dad 93 had a valve replacement & excellent treatment. They pulled out all the stops for him and his age was only mentioned when he was told that he would pass for much younger!!! Obviously everyone's experience is different but I thought 70s were still 'young'. Also noticed that as you get older your definition of what passes for young gets older with you
Age will always be a factor. Our bodies react differently at different ages. My GP told me (based on his own observation of several decades) that older people seem to tolerate AF better than younger ones and younger people generally seem to gain more benefit from beta blockers. They try to postpone hip replacements for as long as possible because you can only have a certain number, so they have to make a judgement on your life expectancy. Doctors decided to not pump my mother in laws stomach out when she accidentally took 3 days of drugs in one day, because of her age. And when she was in her 90s we heard the phrase “at her age” a lot. You cannot dispute that age is one of the factors to be considered when deciding treatment but the important thing is that it should be considered, not used as a blanket cover for how you are treated.
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I don't think Doctors are allowed to discriminate on the grounds of age alone although it can be a contributory factor to decision making along with a patients circumstances and comorbidities.
Just a quick one about little things that can affect us
How long did you wait for your 1st ablation?
Kardia
Flecainade
