Proposal for NHS to limit Ablations and to set criteria for the procedure.

[doodle68]

Medscape UK article..

medscape.com/viewarticle/92...

I am not sure if everyone has access to this article so I will copy and paste it...

[doodle68]

''Concerns have been raised about NHS proposals to limit commissioning for atrial fibrillation ablation.

A consultant cardiologist told Medscape News UK that planned changes could lead to patients having to wait longer for treatment, while people from more socially deprived backgrounds could miss out.

NHS England (NHSE) produced plans for a wide-ranging set of criteria to be fulfilled prior to patients being eligible for catheter ablation for paroxysmal and persistent atrial fibrillation (AF).

The document supported the use of catheter ablation for reducing symptoms of AF, but said that NHS guidance was lacking over which patients would obtain the most benefit from an ablation, which patients would not benefit, or how many times the procedure should be repeated if symptoms returned.

Stakeholders had until last week to comment.

New Patient Criteria

Among the proposals:

No patient would be able to undergo more than one 'redo' procedure without review at a multi-disciplinary team (MDT) meeting

Ablation for persistent AF would only be offered if the patient had a successful DC cardioversion (DCCV) beforehand, and had been tried on rate control with at least two anti-arrhythmic drugs for at least 3 months

Ablation for long standing persistent AF would no longer be possible for patients with a body mass index (BMI) of more than 40

Patients with a BMI of 35 to 40 would need to demonstrate a documented weight loss of at least 10% of their body weight

Responding to the NHSE proposals, Prof Dhiraj Gupta, a consultant cardiologist and electrophysiologist at the Liverpool Heart and Chest Hospital, warned that the policies could result in a significant group of patients being denied treatment, despite evidence showing they would benefit.

"It's going to intensify the very inequalities in health access that the document purports to get rid of," he said. "We know that patients in disadvantaged communities have proportionately higher rates of obesity."

A requirement for patients to have undergone a DCCV before treatment risked lengthening waiting times, according to Prof Gupta, who is also honorary professor of cardiology at the University of Liverpool.

Also controversial was the requirement that a patient should have a minimum trial of drug therapy 3 months after a DCCV with a combination of at least two drugs.

Prof Gupta said he was concerned that this would undermine the importance of speedy treatment, which is linked to successful outcomes.

"Our concern is that by adding this unnecessary step of having to wait for at least 3 months, the reality of the NHS is that if you're only seeing the patient every 2 or 3 months anyway, this is going to add about 6 months to the whole process," he said.

Data suggest that AF ablation rates in the UK already lag behind those in other countries in Western Europe.

In his submission, Prof Gupta warned that the "severe restrictions" proposed by the NHSE policies "will only worsen the situation", while also exaggerating existing regional inequalities.

No comment was available from NHSE.

[Ianc2 in reply to doodle68]

Perhaps every diagnosis of Afib should result in a pre-op rehab course to advise people who fit into the categories identified above of the need to lose weight and attend exercise classes to improve their mobility and get them into a different lifestyle .

Millions of baby-boomers will be hitting the NHS in the next ten years and I am quite sure that the £350,000,000 every month promised on the side of Boris's Bus will make a tremendous difference from February onwards. I am surprised that the NHS has not started planning how to use this new tranche of money.

[Jalia in reply to Ianc2]

Re your first para, can you actually imagine this happening when you can in many cases wait weeks to see a GP, months to see a cardiologist and years to get an ablation, not to mention best part of a year for physiotherapy........

[Finvola in reply to Ianc2]

Perhaps the NHS is planning to use that £350m per week on unicorn meat in hospital catering.

[Gmc54 in reply to Finvola]

Yes. I’ve heard its very nutritious. So much so I am thinking of foregoing my meat free diet forthwith. 🤔😀

[Buffafly in reply to Ianc2]

You don't need a rehab course, you just need a leaflet! I take Dr Gupta's point about disadvantaged people but performing procedures on people who aren't likely to benefit without a change of lifestyle is a waste of resources - I don't think it is too much to ask to require people to put a little effort in themselves. I was told you can't have a hip replacement unless you have completed a course of physiotherapy - in our area anyway, where we have excellent physiotherapy provision.

[Ianc2 in reply to Buffafly]

I have seen reports that cancer patients in the North of England are being put through pre-operation fitness courses to help them withstand the rigour of a long operation.

I have also seen a report, (I think on Medscape) that indicated that major changes in lifestyle can be as effective as medical interventions in dealing with some heart problems. I can't find it now of course...

[Hidden in reply to Ianc2]

Now, now....no politics.....😂😂😂😂

[KMRobbo in reply to Ianc2]

350 MILLION LOL!

[Dawsonmackay]

GLAD I don't live in England. I hate these boards that try (and most times succeed) in overseeing (commissioning!) complicated procedures.

[Buffafly in reply to Dawsonmackay]

We do too if it's one we want, but on the other hand everybody has a chance to have any necessary procedure regardless of income.

[Buffafly]

I was able to read it as it is news so not restricted. Very interesting, I was surprised there wasn't a set protocol for putting patients forward for ablation as it has been my impression that EPs are (naturally) very enthusiastic about it and I wondered if it is not sometimes using funds which could be used on procedures with a much higher success rate. Before anybody leaps growling on this remark I should explain that I have cataracts in both eyes and have had to wait a long time for my sight to get bad enough to be referred for an operation and then a 6 month wait for a consultation, while in the meantime my macular degeneration is progressing, so I've been missing out on years of clear sight which will never be fully recovered, also there is a question mark over whether the procedure will be done at all because my retinas may be too fragile. Am I bitter - yes I am 😬

[dmjtanner in reply to Buffafly]

So sorry, that sure doesn’t sound like great healthcare. I had cataract surgery 2 weeks ago in one eye, and next week the other. The improvement is amazing! I live in the states. Maybe Medicare for all wouldn’t be so great. Although I had to pay extra to have the bladeless surgery. Hope you get yours soon.

[Buffafly in reply to dmjtanner]

Thanks. Do you mind my asking how much yours cost? I presume you paid for insurance? The problem here is that people don't want to pay more to have a better service when they need it, maybe because they don't see a bill. I think it might be a good idea if we did get a token bill, particularly those people who don't keep appointments.

Oh dear, not in a good mood today, I'd better go away 🤐

[dmjtanner in reply to Buffafly]

I will have to wait until I get my Medicare statement which lags behind quite a bit. That will show me what was charged to Medicare and how much Medicare paid. Medicare comes out of my social security and it is $144.60 a month. That’s the same charge for all in the US who get Medicare taken out of SS. I had to pay $1700 per eye above that to have the bladeless (laser) surgery. I could have opted for the regular surgical incision but that isn’t done much anymore. It’s still a steep price. Whenever I get my statement, I can let you know.

[Ianc2 in reply to Buffafly]

Hi Buffafly

I am having a cataract operation on Feb 13th. After 8 months I have given up waiting for an appointment to see a consultant, never mind go on the waiting list for an operation . The operation will cost me £1949 for a single eye, plus a consultants fee of about £160.

I have paid NI contributions for 44 years and I am not happy with the situation. I want to be able to see so I can carry on driving so it appears to be the only option.

[Buffafly in reply to Ianc2]

My wait should have been only four or five months but has been delayed for six weeks. I would go for the private op if I only needed one eye done and if there weren't complications. Your case kind of proves my point I think......

[CDreamer in reply to Buffafly]

You make good arguments on this point Buff - you always have much to contribute. I’m so sorry to hear about your sight & hope you receive treatment soon.

[Buffafly in reply to CDreamer]

Thank you very much for your kind comment 💜

[djmnet in reply to Buffafly]

Medicare pays 100% for the surgery and implantation of a single vision lens. I had to pay only $275 co-pay for the surgery center for the procedure. (I also personally paid extra for multi vision lenses -- about $3000 per eye. Well worth the investment! I now have 20/20 vision for the first time in my life (75)! What a joy.) And there's no waiting for "consultations" or the surgery itself. I love my Medicare.

[Buffafly in reply to djmnet]

Thank you for the information. I don't know how Medicare works, need to do a bit of googling!

[Ianc2 in reply to Buffafly]

Are you on the waiting list for an operation?, If no,t have you considered paying for an appointment with a consultant? I know that health care is supposed to be free but It might at least get you onto the waiting list for an operation?

[Buffafly in reply to Ianc2]

I've had an appointment for a pre op interview with a nurse followed by a consultation the same day so I'm hoping that's meaningful......

It's the optician who refers you for the operation so I'm not quite sure what happens at the consultation?

[Ianc2 in reply to Buffafly]

Good to hear you have a pre -op interview followed by a consultation. In this area the optician refers you to the consultant. There is a waiting list to see the consultant.

After you see the consultant, (who carries out another eye examination) you then get to join another substantial waiting list to actually have an operation. I hope your health system is better than the one that applies around here and you get some good news.

I believe that they only do one eye at a time so try and get them to do your best eye first . Good luck.

Ian

[Finvola]

Interesting article, doodle and thank you for pasting it - I can never get in to Medscape.

I am not really surprised by this move at all as similar structures are already in place for other procedures such as cataracts, varicose veins and many types of minor surgery - all of which may not be so 'minor' to the sufferers. Many may feel that such procedures are 'less important' than ablations but I agree with everything Buffafly says about delays worsening conditions.

There is so much which I think each of us could complain about and/or improve in our NHS provision but the fact is that the alternatives will probably be even worse than the scenario set out in this article. The problem with such a large organisation as the NHS is that implementing change in one area doesn't help the overall picture and taking a sledgehammer to the whole organisation helps no-one.