Can Anyone Explain Why It's so Difficult to get an Alation in the UK?

[BlueINR]

I live in the US, and a few years ago was hospitalized a few times for afib. On the 3rd or 4th hospital stay, an EP met with me and suggested an ablation. He explained it well for me and thought it would help, so I agreed. The ablation was done 2 days later.

When I come to this forum I read so many posts from members who are waiting, waiting, waiting for an ablation, and I don't understand. While it's not surgery, it is minimally invasive with a catheter inserted in the groin, and not sure how time-consuming it is, but I doubt it's more than 3-4 hours. Guess what I'm trying to say, is that it's not a big to-do as a surgery would be, and I cannot understand why many here have to wait such a long time to get one done.

I think it's a fairly small percentage of heart patients that arrhythmias and need an ablation, which is why I don't understand the need to wait so long. Not enough doctors? Too many patients? Anyone have any ideas why most here must wait so long for a relatively simple procedure that shouldn't be more than an overnight hospital stay?

Have a neighbor in my apartment complex who has similar story to mine: a few episodes of afib, and within a few days her ablation was scheduled and completed.

I would think this would be the same almost anywhere that has a decent medical care system. People seem to brag a lot about how great the NHS is, but hearing this about waiting for ablation seems absurd to me.

[BobD Volunteer]

The first thing to say is that any and all treatment for AF is only ever about quality of life (QOL)as it is not a fatal disease. There is no change in end game so long as rate is well controlled and the patient is anticoagulated where appropriate. Ablation is just one of many treatments.

Here in UK doctors are paid a salary not paid by procedure so if they recommend an ablation then you know that they feel that it is worth doing. There is absolutely no point in doing an ablation for somebody for whom they know it will fail. Life style is vital in treating AF and in that it is beholden on the patient to take whatever steps they can to improve their chances of reducing AF burden. We know that weight loss leading to a BMI of less that 26 can in many cases reduce AF burden to a level where ablation is unnecessary ( LEGACY trials) but of course not all AF sufferers are obese. Alcohol is another common cause of AF especially in younger patients which should be considered first.

I confess to being a great fan of ablation having had four but it is not always the panacea people hope and even when it is, the recovery time frame is often vastly different to that which they may be told about.

On balance I am happy I am on this side of the pond.

[Hidden]

I think we could have a huge debate about the pros and cons relating to the differences in healthcare provision between the UK and the USA but because we tend to only know what we hear, it’s probably impossible to make judgments due the complexity involved. As Bob has said, AF when treated either by medication or an invasive procedure is not deemed to be life threatening and is therefore not seen as a priority. That may not seem very helpful for AF sufferers, but when you consider the vast multitude of life changing/threatening conditions which our respective populations are exposed to, it does need to be understood.

The NHS is far from perfect and for reasons we all understand it has been on its knees for close on 3 years but it is there to provide health care to the entire UK population which is close on 69 million people at the last count, free at the point of delivery. It’s therefore not surprising that it has its challenges but does manage to carry out around 11,000 ablations a year.

Although many of us have a moan every now and then, most of the population are very protective of the NHS. It would be very interesting to know how quickly someone living in the States with little or no savings and no health insurance would be offered an ablation………

[Jalia in reply to Hidden]

Re your last para Hidden , that's exactly what I was thinking!

[belindalore in reply to Hidden]

Yes, your last sentence tells a lot about healthcare here in the USA. Sometimes insurance doesn't matter as not every health insurance plan is equal. What one plan may cover the costs of, the next plan may not. There's the saying-"You get what you can afford." Sadly that pertains to health care in the USA.

[BlueINR in reply to belindalore]

I have never had health insurance coverage, either through an employer or now with Medicare, that refused coverage for a medication, treatment or hospital stay. And I've had a lot of health problems, with heart stuff going back to age 8, so it's not like I only need to see a doctor occasionally. I've been hospitalized about 16 times in the past two-and-a-half years, mostly for afib, svt and diverticulosis. I don't feel a bit sad about medical coverage in the US. It's saved my live on more than one occasion.

[belindalore in reply to BlueINR]

I have Medicare advantage. It has refused me various things.

[BlueINR in reply to belindalore]

I have a Medicare Advantage plan also and never had anything declined.

[belindalore in reply to BlueINR]

Good for you. Like I said good care is not the same everywhere. No matter what insurance you have.

[Budken in reply to BlueINR]

If that is the case, you are very lucky. I have had afib since 2010. The first outbreak, I was hospitalized for four days, while they discussed treatment. I was eventually given Flecainide, and the afib stopped within twenty minutes. Since it was decided that I tolerated the Flecainide well, it was the treatment that was given. I inquired about an ablation, and my insurance flatly said they would not pay. Also my Cardiologist was very against ablation saying, " you do fine on Flecainide, why do you want someone to burn holes in your heart? Three out of five ablations fail anyway."

I think perhaps your answer is right here. Since afib is treatable most of the time with medication, why opt for an expensive procedure, that fails half of the time.

[BlueINR]

Some time ago when I was in the hospital being treated for afib, doctor explained to me that even though afib is not a fatal arrhythmia; it is possible that it can turn into one; therefore it is best to treat it if it does not resolve fairly quickly on its own. For some, that happens, though it never resolved for me without a cardioversion. I am allergic to amiodarone, one of the more common drugs to use IV for treating afib, and when other meds didn't work, it was cardioversion (probably well over a dozen) that got me back into NSR.

As for those living in the states with little or no income, and no health insurance, they would most likely qualify for Medicaid, medical insurance coverage that varies somewhat from one state to another, and assures medical insurance coverage for those who do not have it.

I was in that situation when I had my ablation. No private insurance; however, I was covered by California's Medicaid which paid for hospital stay and ablation.

[RoyMacDonald in reply to BlueINR]

California is one of the best States for Medicaid. Not all States are equal. Also one Dr's view that AF can turn fatal is not born out by the statistics. I'm guessing he is biased by the need to preserve his income. As a well known Cardiologist here said "it's not AF that kills but the company it keeps."

[belindalore in reply to RoyMacDonald]

So true. Not all Medicare insurances are equal. They vary within every state and around the country. Neither is Medicaid equal. It varies state to state also. Healthcare is not what it once was here in the USA.

[jeff1257 in reply to belindalore]

Traditional Medicare is the same in every state.

[belindalore in reply to jeff1257]

Not talking about traditional Medicare. Medicare advantage is not the same in every state. Traditional Medicare pays 80% of costs. People buy supplemental plans to cover the other 20%. Those who can afford it. Medicare advantage is supposed to cover everything that original (traditional) Medicare covers. It doesn't always. Medicare advantage includes coverage for meds and covers Dr and hospital costs. It depends also where you live and whether or not you have good Drs. The problem is that the insurance companies dictate what Drs can and cannot do. I'm in Florida and the county I live in is not known for the best healthcare or Drs. I know a lady who lived here and got crummy care. Moved to Texas and kept the same insurance she had here but is now getting much better care. I have friends who are snowbirds and they all say they would never get any major care here. If they had to crawl they would go to their home states to get treated. Insurance plans, care and Drs are not all wonderful anywhere you live. There are a lot of problems with the medical system in this country.

[BlueINR in reply to RoyMacDonald]

I was not told by any doctor that afib could be fatal. What I was told that while afib is not a fatal arrhythmia, it could turn into one that is.

[RoyMacDonald in reply to BlueINR]

"even though afib is not a fatal arrhythmia; it is possible that it can turn into one; therefore it is best to treat it if it does not resolve fairly quickly on its own"

Must be the language barrier then as I read that as, it can turn into a fatal arrhythmia. Or maybe it's just my stroke damaged speech centre. I had to learn to write again and not say what I was thinking as I kept upsetting my friends and family.

All the best.

Roy

[Buffafly in reply to BlueINR]

Anyone here with the same degree of severity of AF - several stays in hospital, always needing cardioversion, most powerful anti arrhythmic med doesn’t work - that’s extreme, would probably get an ablation pretty quickly too. Obviously your doctor thought it was very serious. People who need pacemakers here sometimes get them almost the same day. So we’re not really talking like for like.

[BlueINR in reply to Buffafly]

It's not that amiodarone does not work for me, I am allergic to it. Had it numerous times with no problem, and one day nurse started IV of it and I started going into anaphylaxis. No more amiodarone for me!

[Budken in reply to BlueINR]

I was told right from the start, that afib was not a fatal disease, that it was treatable, and as long as it was asymptomatic, one could lead a normal life, without worry.

[CDreamer]

The main difference between the US and UK is the politics. Everyone gets a fair chance here in UK and doesn’t matter who or what you are or how much money you have. I think BlueINR & BobD have said it all.

I don’t like the way the US system works - and yes I have had some experience. I don’t always like the UK system works either but I know which one I prefer. The way I see it - UK system looks at Health Care as a what is a priority for the good of the whole whereas the US system predominantly looks at what is the priority for good for the profit of the company or individual doctor.

It seems to me that all Health Care in both countries and many others are currently in crisis and there is no ideal system - so each to their own and let’s not criticise each other’s.

[Coeurdelion in reply to CDreamer]

I don't think the French system is in trouble. Response times there are fast. Once the GP passes you to a consultant one deals with them directly. Anecdotally there are no gp waiting times and consultants contact is within weeks not months/years. It's all about resources and how the government funds it. We don't necessarily need "tax cuts".

[CDreamer in reply to Coeurdelion]

It’s variable in the UK and other posters in France do report difficulty.

[Auriculaire in reply to Coeurdelion]

On the whole I think the French health service is much better than the NHS having experienced both. I left the UK when Labour was in power but still had some very poor experiences both in A&E and having a hysterectomy. Maybe it was just Birmingham! My experience here is that you wait longer to see a consultant at a CHU ( University teaching hospital) than at a private clinic. Our insurance enables us to have ops at a private clinic so I have no idea what the waiting time would be if having the op in the public hospital. I have had scans of various types at public hospitals with minimal waits and was kept in a private room in coronary intensive care for several days after my first afib attack ( till my INR was satisfactory!). I cannot see that ever happening in the UK especially as NSR was restored within hours on a drip. This was at our local public hospital and in the summer hols when personnel are usually in short supply. However at my last GP appointment my GP (who is better than any GP I ever had as an adult in the UK )said that he was wanting to retire but having huge difficulty finding someone to take over his practice as young docs don't want to live in the sticks. I have read a lot in the French press about " déserts médicaux" but always assumed it was in really remote areas .

[belindalore in reply to Auriculaire]

It's hard to keep Drs in the rural areas in the USA too. More money in the big cities.

[BobD Volunteer in reply to Coeurdelion]

My sister who lives in central France came over to visit me in order for her to have microsuction in her ears as the earliest appointment they offered her was late October and this was May! And neither side was free! Nothing is working right now wherever you are.

[belindalore in reply to BobD]

Sadly I think you are right BobD. Nothing seems to be working right no matter where we are. 😞

[Lilypocket in reply to Coeurdelion]

I live in France and even during Covid had no problem seeing a Dr. Also GPs here don't have as wide as an experience as UK GPs who see and treat more pathologies which is good and bad as it might delay the speed at which you see a specialist Here you get referred to a specialist fairly quickly ( in my experience). Also I often go straight to a specialist and tell them who my GP is ( everyone has to have a declared GP if you are to be re- imbursed). They just ask me who my Dr is and they send any reports straight to him. Then at least I'm not hanging around waiting to see a GP for a referral. But I'm a big fan of the NHS - they saved my father's life after a giant aneurism and massive internal bleeding. Hats off to Liverpool! The nurses in the ICU were cheerful, sympathetic and reassuring. It is not always the case here in my experience.Well enough waffling

😅Take care x

[Coeurdelion in reply to Lilypocket]

So it seems you agree with me that France is quicker even if you are a fan of the NHS. I know many instances of the way the French system works well and regrettably, how bad the system is currently operating in the UK.

[Lilypocket in reply to Coeurdelion]

Difficult to say I have been out of the UK for 32 years so I am unable to have an informed opinion on today's NHS. The hospitals are also underfunded in France and we had Drs out in the street protesting a few years ago and there is grumbling here now. There are faults in all sytems mainly due to underfunding in my humble opinion.

[Coeurdelion in reply to Lilypocket]

Agreed but I have lived 50/50 france and England for the past 16 years and the UK system that I see is close to breakdown.👍

[Lilypocket in reply to Coeurdelion]

Where are you in France?

[Coeurdelion in reply to Lilypocket]

Tarn et Garonne, Occitanie

[Goldfish7 in reply to Coeurdelion]

Sadly because succesive Tory governments have run it down so that they wont get as much public backlash when they fully privatise it. Unfortunatly Sunak has been in advanced talks with US health providers last year and a lot of bits of the NHS, including our NHS data is now in the hands of US firms - very scarey!!

[belindalore in reply to Goldfish7]

Yes. That is VERY scary.

[belindalore in reply to CDreamer]

As I say the USA has become too much profit over patient.

[Budken in reply to CDreamer]

You hit it on the nailhead! Here in Europe the good of all, is first considered. In the US, many procedures are recommended by doctors, who will profit from having performed them. There is no government control regarding costs. Both my Cardiologists in the US, said that Ablations were simply one way to control Afib. That they were promoted by Hospitals, and certain Cardiologists, who made a huge profit from them. Here Doctors are paid salaries, not by how many patients they treat, or by what procedures they perform. The American system is based simply on profit, not on altruism.

[Singwell]

Your cardiologists, and all medics as I understand it, work for or are for profit organisations. The NHS is not. Simple as that. Ablation = hospital time, staffing, expensive equipment. To have it done privately costs around £12000-£15000. There's your answer. For those without medical insurance in the US - how long is their wait time?

[Dr-Gohan in reply to Singwell]

I live in the US and I married a Brit. Her family living in an around London can afford private insurance and have no complaints. I am retired and on Medicare insurance which pays far lower rates to providers for every procedure be it a simple office visit or Ablation.I was diagnosed in September 2019 with AF and medications were given and cardioversion without satisfactory results. Then my Cardiologist referred me to an EP in 2021. The EP suggested a PaceMaker implant with a Defibrillator built-in. The procedure was complete in March of 2021 and in April I asked for and received Cryoablation. This worked immediately and have remained in NSR since. My quality of life has returned to near normal. I am 76 so it is difficult to be certain just what aches an pains I should blame on my age, medications or my heart condition. I will say that I feel good almost everyday and when I don't, I like to go into town and socialize or walk the dog to relieve my temporary malaise. All in all I wake-up and wiggle my toes and try to remember all the things I am grateful for. That's my best way to start my day. I refuse to watch the News, nor do I have anything to do with political reports and/or discussion. Stress is for people who are better equipped than I to handle it. I have spent hours researching Heart health and came around to eating almost entirely a Plant-Based diet. My BMI has settled-in at 24 and I can eat all the fresh fruit and veggies I desire.

I drink a full glass of water as soon as I am out of bed and throughout the day.

I started visiting the UK in 1980 and feel in love with the culture in the first 24 hours.

I have never had to access the NHS. I believe in the US the approach to treatment is try the cheapest solution first and hence to waiting for 20 months to finally see the EP and have the Ablation which thus far is still working the wonder which is a Heart in NSR.

God Bless

[Singwell in reply to Dr-Gohan]

Thank you. I guess that it's easy to make assumptions when looking across the pond without knowing how systems work. Appreciate the sharing of that plu your strategies. Am the same with stress and also drink about 3/4 of a liter of water on rising.

[belindalore in reply to Singwell]

Not everyone has the same outcome as Dr-Gohan. Because as I've stated many times not all Medicare insurances are equal.

[Lilypocket in reply to Dr-Gohan]

What a nice message!Do you know why they didn't offer the ablation before the pacemaker and defibrillator or are they something you need in combination with an ablation ?

Take care

[gerickson021 in reply to Singwell]

I live in the US and do not have insurance. The wait time is about 10 days for my local EP and two months for Dr Natale, an known expert in ablations. What is outrageous is the out of pocket cost, I go two quotes, $40K and $50K! And that doesn't include any hospital stay. I elected to get mine in Mexico, the private care there is on par with US. Plus doctors there are open to new ideas and not bound by the legal standard of care.

[theohappy in reply to gerickson021]

Hmm, I had my ablation done by Dr Natale's partner. I am a self pay patient, but old enough to have Medicare Part A to cover the hospital portion. St David's gave me such a huge discount that Medicare Part A had to only cover about $29k. I was left with about $2,000 to pay out of pocket. And, because I am a part of a health-care share program where members meet the medical needs of others, that was covered too. Along with all the doctor bills. Just thought you might find that interesting. Glad everything went well for you in Mexico!

[gerickson021 in reply to theohappy]

wow, how did you get Medicare part A to cover? Scripps and HCA (where Dr Natale works) quoted $40K cash by me. said Part a didnt cover (no hospital stay?).

[theohappy in reply to gerickson021]

Well, first of all I guess we are talking about two different Dr Natale’s. Mine is in Austin, TX. Also world renowned for ablations. But I was admitted overnight, so Medicare picked up the tab.

[gerickson021 in reply to theohappy]

Same DR Natale, he also practices in Thousand Oaks. I think were really lucky then, normally he is booked two months out. I will see if I need another if they admit me to get Medicare A

[theohappy in reply to gerickson021]

Wow! Had no idea he traveled around that much. I almost participated in the PFA trial. Where Dr Natale is heading up in Austin. I would have either gotten the new Pulse Field Ablation or a RF ablation. But I needed a Watchman device due to stroke risk and intolerance to blood thinners. And I would have needed to wait a year until trial was over for Watchman. So I passed.

[Ericmax in reply to Singwell]

I guess the dead ones don’t count.

[Singwell in reply to Ericmax]

Not sure which part of the thread this relates to?

[Buffafly in reply to Singwell]

Wait time in US?

[belindalore in reply to Ericmax]

????

[RoyMacDonald]

Reminds me of Turner when asked whose seascapes he preferred and he replied which pie is best Pear or Gooseberry?

[RoyMacDonald]

Covid has a big impact on all procedures in the UK, also the lack of the Tory Government funding over recent years meaning that Nurses salary levels are not being maintained meaning that they are leaving the NHS to work in the private sector.

All the best

Roy

[belindalore in reply to RoyMacDonald]

Same thing happening here in the USA. We are getting a lot of foreign Drs coming here to practice. Many good Drs also retiring early because they are tired of dealing with the insurance companies.

[RoyMacDonald]

Forgot to say that the best procedure for AF is not an Ablation, but the Wolf Mini Maze in my opinion. I'm guessing they would not offer it to you under Medicaid?

[gerickson021]

Socialized medicine. The same situation exist in Canada, someone posted one time it was year wait there.

[jeanjeannie50 in reply to gerickson021]

I'm in the U.K. Was offered an ablation on the Friday and had it the following Wednesday. Also I get to speak to my GP the day I call, if an appointment is necessary will see her that day.

Let's not get into this petty who has the best medical system. I guess there are good and bad experiences in all of the countries posting here.

Jean

[BlueINR in reply to jeanjeannie50]

It was not my intention to compare which countries have the best or better medical care systems. Have just noticed when I come here to read posts, so many seem to write they're waiting for an ablation. I assumed since I got mine so quickly that most others did also. It may very well be a matter of how not well one is doing that gets one an ablation quicker than others. I was in my 3rd or 4th episode of afib when it was done, and previous to that, no meds worked, only cardioversion would get me back into NSR, so I guess I was worse off than I was aware of.

In any event, I hope all get the treatment needed to deal with afib, as it's not a fun place to be.

[Ericmax]

Socialist healthcare.As bad as in🇨🇦

[lacolyn]

I've just returned from California to Sussex UK. I had a severe not of afib, evacuated to Scripps, discharged after 5 hours, still in afib but below 100 bpm. At 3am mext morning I awoke drenched in sweat, totally disoriented, in extreme distress. Within 30 minutes of calling the first responders I was back in across and sun given a cardioversion. Of had an ablation in UK about 8 years previously. Great care in Scripps. More waiting for the big bill to give to my holiday insurance company. On discharge the US doctor told me to "see my cardiologist and primary carer" as soon as I was home. I laughed. It's not possible in East Sussex. West Sussex and other parts of UK yes but here no. I've come to France on holiday now and, feeling bellows parr, walked into a local surgery and was seen immediately. The NHS had been run down and sold off progressively over the past 15 years, irrespective of Covid. It's in major trouble and Brexit hasn't exacerbated the situation. I'm not saying it's all political, but it is. I've had superb treatment in all 3 countries I've mentioned but I'm English and my heart is not just in me, it's in England and I want it to stay that way. But I'm so glad I am able to travel and, without being rich, can use the health systems available, for the moment at least.

[Jpot34]

Socialized medicine in the UK. Same with Canada. The US is well on its way after Obumma got his hands on it!

[theohappy]

My comment is to others in regards to how quickly a patient can get help who does not have insurance and lives in the U.S. I have Medicare Part A, which only covers hospitalization. Otherwise I am considered a self-pay patient. Although I am part of a health-care share program where members share each other's medical needs. I have been a part of this group for 23 years. I pursue my own doctors, of my choosing. Rarely have I been denied medical, but there are some doctors who will not accept self-pay patients. Fortunately, so many more excellent doctors who will. When I went into persistent AFib and felt just horrible, I was scheduled for an ablation within weeks. I received excellent care at one of the best hospitals.