A Fib - is it normal for GP to prescribe medication?

[dunestar]

Yesterday I was told by a nurse at the local hospital that I have A Fib. There is a long history to this which I won't bore you with but suffice it to say I've decided to make a complaint to this hospital about my treatment. Anyway, the nurse has said she will write to my GP and suggest he prescribes medication for me. Is it normal for a GP to prescribe the medication or is it usually in the hands of the hospital consultant?

[bantam12]

My cardiologist decides which med to give me then asks my GP to prescribe it. My GPs don't have anything to do with my heart problems other than repeat the scripts.

[dunestar in reply to bantam12]

That's what I thought bantam 12, but problem is this nurse is more on the ball than the cardiology team!!!!

[Hidden]

I believe that only consultants can initiate treatment with “rhythm control drugs” for AFib and flutter, like flecainide, propafenone, amiodarone, dronedarone, sotalol and dofetilide [ not in UK]. GPs in UK can start treatment with “rate control drugs” like digoxin, beta blockers other than sotalol, calcium channel antagonists. I’m not a doctor. Don’t quote me!

[jeanjeannie50 in reply to Hidden]

I agree with Badger. My GP has tried me on and prescribed different beta blockers, but rhythm control meds have to be authorised by a consultant or EP.

[KMRobbo in reply to jeanjeannie50]

I agree with Jean and Badger. When first diagnosed AFib the hospital out me on Bisoprolol rate control, and I could not tolerate it. So my GP changed me twice to get some thing I could tolerate. 20 months later my AFib progressed for the worse and the cardiologist s at the hospital had to put me on Rhythm control meds (flecainide) and had to also change the rate control meds to work with it. From that point the GP had to get the hospital cardiologist to amend the dose ( which actually entailed just getting me an appointment with the cardiologist at the hospital ). Later I got an EP at a different hospital as I wanted an ablation and after that any med changes had to be done by him.

This was apparent when my local hospital changed my meds wrongly and cancelled my flecainide prescription ( long story ) and my GP had to track down my EP to get it reinstated whilst I was in the surgery as I had run out of flecainide!

[Lacarno in reply to KMRobbo]

What is EP short for ?

[KMRobbo in reply to Lacarno]

Electrophysiologist - a cardiologist who specializes in arrhythmias, BobD classifies them as electricians and "normal" cardiologists as plumbers as arrhythmias are often (always??) caused by irregular electric signals.

[Paulbounce]

As far as I'm aware only a cardio or EP can prescribe certain med's - Flecainide being one such example. Your GP can't do this.

However he / she can refer you to see a consultant. May I suggest you ask your GP to this ?

Paul

[dunestar in reply to Paulbounce]

I have a cardiologist Paulbounce but I'm in the rather difficult position that a nurse diagnosed my A Fib, not the cardiologist. I know, I know... but this nurse took the time to track down the data from the paramedics when I was admitted to hospital. But the consultant hasn't bothered.

[Paulbounce in reply to dunestar]

Nurses do indeed do marvelous job. 10 out of 10 from me.

Paul

[pottypete1]

Normally the GP writes the prescription on the instructions of the Cardiologist.

Pete

[Finvola]

My consultant decided on rate and rhythm control drugs but my GP was able to change my rate control drug without referring to the cardiologist. I wonder if your nurse is keeping your GP involved by asking him/her to initiate treatment and/or referral to a consultant?

[dunestar in reply to Finvola]

She's doing the work the consultant should have done!

[BobD Volunteer]

GPs may prescribe beta blockers or other rate control drugs but not rhythm control drugs which must be initiated by a consultant. Since beta blockers are the first line treatment alongside anticoagulation this sounds normal procedure.

[Hidden]

My EP said it was an error to immediately prescribe rate control in my case. I haven’t found my GP as wise as the EP or AF nurse.

[Hidden]

In hospital the doctors there only give you a prescription for a few days up to a week even for antibiotics you have to go back to your gp to get the rest of the script filled and the gp can alter a prescription...like if you got side effects they can change your medication until you get to go back to a specialist. But the hospitals can only give out a script for a few days and so for ongoing prescriptions it has to be gotten by your gp. So you might get a script going home from the hospital at first but he would tell you you need to get the rest of your dose from your gp.

[AstroFish]

The cardiologist, in my case, prescribed the anticoagulant when I was diagnosed but left it vague as to which one exactly and merely recommend EDOXOBAN, and the GP changed it to APIXABAN from EDOXOBAN. We checked with the cardiologist first and I’m thinking that perhaps your GP could simply contact the cardiologist to let her/him know what’s been prescribed. Or to check that is ok. I’m sure the cardiologist would be contactable - or perhaps I live in cloud cuckoo land and they’re generally inaccessible? My GP got through to mine ok though. Also I would expect the hospital to write to your GP with details of what you’ve been diagnosed with ...would that letter not contain details of drug choices? Good luck sorting it all out. I’d say the GP contacting the cardiologist through his or her secretary is a sensible first step.

[Morzine]

I’m in France but cardio decided my tabs....I see him every year and in between my doc dishes the prescription mid way at six months...

[Auriculaire in reply to Morzine]

Ditto.

[Morzine in reply to Auriculaire]

Have u been jabbed yet? I’ve been told the doc will ring me next week with appointment fir Astra zenica...can’t wait....but my hubby 74 wint be done yet as he’s fit and healthy....

[Auriculaire in reply to Morzine]

No . I have not had a letter yet. I am undecided about being vaccinated for the moment. I suffer from Fluoroquinolone toxicity and I have had problems with flu jabs so I never get them now. Many things can cause relapses with this condition and I had a major relapse after my hip replacement surgery in mid Dec. I am just starting to recover from that now and am very wary of bringing on another one.

[Morzine in reply to Auriculaire]

I get what you say. It’s a worry if you’ve had reactions such a tricky decision eh. I am wary but I’m going to have it as I had an illness years ago that lasted ages and I’m scared of that long covid as I did a post viral sentence that ruined my life fir a couple of years . I don’t think they send out letters with this Astra Z qualification ,we r part of the 50 plus with comorbities list....you must ring doc and they will then get back with an appointment. But I’ve just seen the pharmacies here are doung it from end if next week too....

I think it was crazy France let the holidays all go ahead we had masses of families tourists here this last month in morzine. Buses were crammed taking them up to the snow, ice rink was full....madness!

[Auriculaire in reply to Morzine]

Seems barmy to have packed ice rinks but no skiing! The symptoms of FQ toxicity are spookily like those of long covid. I suspect some people who have been in hospital have been given an FQ as a prophylactic or treatment for a bacterial infection of the lungs and have been floxed!

[Morzine in reply to Auriculaire]

Yes packed ice rinks and tourists info organized masses if activities fir the families.....then the buses hauled masses up the mountain to go walking etc...yet no lifts were allowed open.......cafes were selling vin chaud outside.....morzine was crazy....Tom and I went there and I said let’s walk thru the back streets there’s nobody there....I took my mask off to blow my nose and the gendarmes car stopped and told me off for not wearing a mask!!🥺😟 In an empty street when the high road was full of tourists some nit masked.....I felt totally scolded!!!

[Tryfan]

I'm no expert. I understand that certain drugs like anti arrhythmia are initially prescribed by your consultant. Follow up doses by your GP. GP's can of course prescribe other drugs like hypertension or anti clotting.

[Frances123]

I agree with everything said re who prescribes what and GP follows up with repeats. I’m sorry you are having a tough time but wonder if when your nurse was tracking down information from paramedics she then called the cardiologist to confirm diagnosis from data and/or what drugs to suggest to GP to prescribe/try. Whenever I have been unfortunate enough to be taken into hospital one paramedic is off uploading information into the system before other one has me in the cubicle. Within minutes everything is on the computer for anyone to see and maybe cardiologist was able to do that? Hope you get it sorted and will soon feel better. X

[dunestar in reply to Frances123]

Thanks, yes I think that would be the right way to do things - for the nurse to refer back to the cardiologist.

[spinningjenny]

I am lucky enough to have a GP who used to be a heart surgeon so I would trust him to make necessary changes. Even so, he has on occasion changed doses but not the drug itself. I think the original prescription should always come from the consultant.

[C66t]

You need to see an EP at least a cardiologist. There are tests that need to be done if you havent had them by now, heart echo .chest xray .stress test.hyroid blood test. Holter monitor. Your chad score is important for stroke risk assessment take a look at Sanjay Gupta York Cardiology or stopafib.org.best of luck ket us know how you get on.

[Lacarno]

Well my Doc had a word with my cardiologist and put me on Rivaroxaban and also Ranolazine think that’s right and recently upped my Bisoprolol feel much better but very tired some days but that’s normal