I received a text from my GP saying my annual review is now due. This is new to me and haven’t had one before. Rang surgery, receptionist was a bit vague but said it was for a blood test. Was told it was 2 appointments, one for bloods and one with health care assistant to go through results. She said it might be to do with medication or something that had happened to me? Nothing has happened to me? I booked but rang back as remembered I had a blood test a couple of weeks ago. Different receptionist but apparently that one didn’t include a FBC.
I then checked my records to see if it would tell me more and there were two entries. First said:
“Long term condition care planning invitation first letter”
That’s understandable. Then second entry said:
“Quality and Outcomes Framework quality indicator-related care invitation (procedure)”
Looked it up and its to do with a system for the performance, management and payment of general practitioners in the NHS. Does that mean it shows how many patients they have with long term conditions and cost to each surgery? Hmm, wonder if they’ll try and change me from Apixaban to the cheaper one? After 7 years and no problems I’m sticking with Apixaban.
Just wondering if anyone else has had this out of the blue and what to expect. I could have refused but it could well be to my and the GPs benefit and I’m all for that.
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Frances123
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It sounds a bit like the NHS health check which is 5-yearly for people with no known cardiac or metabolic health conditions. As you have a diagnosis of AF the 5 yearly health checks may longer apply and it may be the case that you need more regular monitoring. That’s all. I wouldn’t be overly concerned. There shouldn’t be any imperative to change your medication if you are stable and/or your consultant has recommended your current prescription. Seriously, I wouldn’t worry. The NHS health check is typically an appointment for blood tests and a follow up with a HCA who discusses your results, probably takes your BP and records your weight. This sounds similar but it’s probably prudent to have these checks annually as you have a diagnosed cardiac condition and it’s always better to be safe than sorry.
Thank you for that. Oh I’m all for better to be safe than sorry. I’m not worried but was confused as it sounded like something I’ve been having. Ive had Afib for over 17 years and never had one before. The receptionist being a bit vague I wondered what it was all about. As I said, I'm all for doing my bit but it is nice to know what’s going on. Thanks.
QOF is the standard by which GP's pay is calculated. It was brought in during the Blair administration and I have mentioned the sytem many time over things like statins etc. Don't worry Frances it works in your favour as at least they know you exist.
Thanks Bob. As soon as I saw QOF on my notes I wondered if it was that. I am 70 in just over 5 weeks and wonder if that had precipitated it as well. Will be interesting to see if statins is mentioned. Trying to research those and make an informed decision is a minefield!
It could be reaching your 70th birthday. The NHS health checks are for people between 40-70. I’m not sure what happens after that. Anyway, a 70th birthday is something to celebrate so I hope you’ll have a nice day when it arrives.
Thank you. It’s usually just another day as it’s 3 days before Christmas and up to my neck in last minute Christmas things. I guess being another big 0 though I might just treat myself to something nice 😋
I’ve always had what my old GP surgery called Annual Healthy Heart review since I was first diagnosed in 2007. Blood test FBC, liver & kidney, ECG (sometimes), BP, urine sample, weight/height and general questions. Second appointment was to discuss with nurse practitioner but after I was lectured by a junior, very overweight nurse on how often to eat processed meat ie: bacon, I never went back for the second appointment since as I reckon I knew just a tiny bit more about nutrition than she! I now access all my results on line.
It’s best practice for anyone with chronic illness, always has been as far as I am aware.
Many posters here say they have not had one or knew about them or ever offered one, then I would worry!
The statins question may come up - usually does. Just do your research before you agree - practice gets paid for asking the question, not for making you take them.
Thank you. I have had an annual blood test for about 10 years because of Flecainide. Invitation for a health check is a new one. I replied to Bob I also wondered if it was because I’m 70 in 5 weeks? Have been reading about statins and will have to read more.
That’s what many people say, it’s an overweight HCA or nurse talking about healthy eating. They’re only repeating a script, but it doesn’t look like the follow their own advice. My husband was told off for having a bit of maple syrup over his fruit and yogurt after dinner. He’s not overweight but the HCA definitely was. I’ve never been “told what to eat” though. They’ve asked about fruit and veg etc, and I’m more like 8-11 portions a day and averaging 50g fibre/day according to when I check on MyFitnessPal so they will usually say “oh well, looks like you’re doing well on it so just carry on doing what you’re doing”. I don’t get the wagging finger treatment. To be honest, a lot of my “good” blood test results and low-normal BMI are down to genetics and not so much anything I “do”. For some people their genetics go against them, and that’s tough, especially in a society that attaches stigma to the idea of health and weight, which leads to prejudiced attitudes towards who is “deserving” of healthcare.
Just as an aside, whenever I have attended cardiology outpatients, it’s a completely normal cross section of ages and body types, they don’t fit the “obese” stereotype of people who have ate and smoked and drank their way into ill health.
My Dad was discovered close to Diabetes when he joined the engineers section of the army WW2.
I have never liked sweet.
It is now a waist measurement thing which is attainable and 'nice' to work on folks who are visibly over weight.
But BMI slightly over is good for women. My bone density was minus .5.
No osteoporosis. No arthritis. Just dry skin!
Just as well as thyroxin has a ? of causing osteo. And I'm taking it to live.
I saw a new Dr who asked me to stop cheese and meat. I said NO.
I eat cheese low fat and best cuts meat or no fat - lambs liver but with a strip of bacon!
We dont want to hate living because all nice food is taken away.
Maple syrup is natural like honey.
My former husband had porridge good but loaded it with full cream, and raw sugar. Did lots of heavy lifting in his job. Until he went on long honeymoon with me S America. Tucan Bus. White bread, ham and cheese and he loaded his bread with butter. I put on weight too without butter.
I don’t think there’s one way of eating that suits everyone. So many individual variables come into play. There’s also how your gut bacteria have adapted your habitual diet over the years and to a large extent we inherit our default gut microbiota during the birth process. It’s quite an interesting area of research.
Agree, we have to enjoy what we eat and our mental wellbeing is important too. Too many women spend years on and off diets and I wonder if they can enjoy food without it being some sort of “guilty secret” that they feel they have to go into hiding to enjoy. What a terrible way to live.
I’m lucky (?) that I enjoy what is considered “healthy” food and I don’t really like junk food at all. I find it actually lacks enjoyment and doesn’t taste that good, especially when you’re not used to it. I end up wondering what all the fuss is about.
Looks like you’ve found a way that works for you. I don’t mind oats cooked with water, that’s how we always had it at home and yes, with a little bit of salt. I do love a savoury porridge with lots of veg cooked in a bit of stock, and sometimes I like to spice it up and make a porridge curry with spinach, cauliflower and tomatoes.
You have reminded me to use up the Scotch fillets juice and veg to combine with my oats tomorrow.
Oats should bring down BP.
Just been into Kaitaia for vehicle service. Popped into the casual foodie place and had 100gms Lamb roast, one kumara and 1 butternut piece. With gravy over meat. Yummy.
Finished it down with a milkshake - spearmint.
A treat I will have if I go to Kaitaia.
Awanui opened a new NZMCA park last week with a roasted lamb. I didnt go but it is a helpful connect to Cape Reinga THE TOP.
Keeo eating sensibly. Elle wont tell me her cholesterol! Enjoy your food.
I had a full blood test 3 months ago and my cholesterol is high and has increased during the lockdowns. It has been higher previously but i was not put on statins because of quite high good cholesterol ratio.I got all my last 10 years + data off the NHS website and made a table from it all, which proved I was no worse than previously when I was not recommended statins My new GP still thinks i should be on them ,but I refused and said I would get the cholesterol down by diet and excercise as i did in 2013, and lowered the bad significantly.
Suspect I have spectacularly failed on this so far as I have not lost ANY weight but this is a good reminder to resolve to do this!
I think you should address high cholesterol, just not through statins!
Yup I've had one. They're trying to catch up post pandemic and I suspect they're also trying to get stats to show that what they do is worthwhile. These checklists don't mean much to the individual but getting your bloods done is always worthwhile. Cholesterol, blood sugar, thyroid, electrolytes, liver abs kidneys etc. All important stuff.
And as CDreamer says- watch out for the statins question! I was most indignant that these were suggested to me - when I queried this a more sensible GP said - you get a high risk factor due to your AF but your good cholesterol is nice and high, and your blood sugar fine. Essentially nothing to worry about. It's an algorithm.
Oh I will. I actually had a cholesterol test about 2 months ago and it was 5.1. Said on notes no further action required. Will certainly question why if statins are offered after GP said no further action recently.
Nothing to do with my AF but I was sent an appointment for the Asthma Clinic, supposed to be yearly but because of covid they stopped. Trying to catch up.
You should be having a blood test at least every 6 months if you are on Apaxiban to check it is not having an adverse affect on your kidneys and liver. This is routine and if you are not receiving invitations from your surgery for this you should ask why.
Thank you. Would be interested to know where you got your information from as everything I have read doesn’t suggest regular blood checks for Apixaban. It does for Flecainide and I have one every year.
If you read the Monitoring section of the NICE Apixaban recommendations, it gives all the details you need. More monitoring recommended when you start Apixaban, then usually a yearly blood test, but for patients =>75 the recommendation is a blood test every 6 months.
There is no need to monitor the international normalized ratio (INR) in people taking apixaban; however, regular follow up and monitoring is recommended.
At the start of treatment, baseline clotting screen, renal and liver function tests, and a full blood count should be performed.
Once treatment has started, review the person on a regular basis, preferably after 1 month initially and at least every 3 months thereafter. Follow-up intervals may be longer (up to every 6 months) or shorter (for example every month) depending on patient factors, such as renal function, age, and comorbidities.
During a review:
Assess adherence to treatment.
Look for signs of bleeding or anaemia.
Ask about other adverse effects of apixaban.
Assess for features of thromboembolic events, such as symptoms of stroke, or breathlessness (which may suggest a pulmonary embolism). See the CKS topics on Stroke and TIA and Pulmonary embolism for more information.
Ask about the use of other medications, including over-the-counter (OTC) products, to identify possible drug interactions with apixaban.
Assess and minimize modifiable risk factors for bleeding, such as uncontrolled hypertension, medication predisposing for bleeding (such as aspirin), and excessive alcohol intake.
Give appropriate information and advice on apixaban treatment. See the section on Advice for patients for more information.
Repeat the full blood count and the renal and liver function tests yearly for most people.
If the person is frail or older than 75 years, repeat the blood tests every 6 months.
If the person has a creatinine clearance (CrCl) less than 60 mL/minute, the frequency of monitoring (in months) can be guided by the CrCl divided by 10. For example, every 3 months if CrCl is 30 mL/minute.
If the person has an intercurrent illness that may impact renal or hepatic function, repeat renal and liver function tests as needed.
Manage any problems identified during a review or from blood test results.
If renal function has declined, review treatment — apixaban may need to be stopped or a lower dose may be required.
If there is an unexplained fall in haemoglobin and/or haematocrit, occult bleeding may be present (apixaban can cause bleeding from any site) — stop treatment with apixaban and seek specialist advice.
I'm on PRADAXA 110mg x twice and that is under the spotlight.
Reading it says Apixaban is the safest.
A death 2 years ago of a patient in Palmerston North He has on River.... and he was discovered with kidney trouble. He had a stroke was hospitalised and had another and died. His wife said use the antedote for River.. but they didnt.
I wonder why she said that .. as if he had taken a double dose.
We all need to stay on routine to check our med taking.
I have a bag which contains early morning meds SYNTHROID and Diltiazem. So take my thyroid pills under tongue. Its early so I may go back to sleep so I leave Diltiazem out. Then I see the morning PRADAXA to take later in the morning.
Another Smarties tub holds my Bisoprolol and Nitrun tabs and double sets of PRADAXA. I take B & N at 8pm. and then PRADAXA ripped for 1 and leave other further over on the tableside.
If I get sidetracked and I don't remember taking I will leave it out.
We cant afford to doubledose. With Diltiazem I would find probably little H/R. Pradaxa bleeding internally etc.
Joy, the new anti-coagulants do not need frequent monitoring of the INR as Warfarin does. However, I believe the NHS recommends an annual blood test to check liver and kidney functions when on Apixaban. My surgery also checks my weight to make sure the dosage is correct. My annual blood test is booked for next week
As I said I have a 3-mthly blood test and monthly for TSH to keep up with changes taking Synthroid but I am getting more confident in staying at 2.0
I take 125mg 1 x 100 and 1 25 but 1 day in 2 weeks I need to take 1 x 100 and 2 x 25s. That's how sensitive the result is.
I then stay on 21.5 level T4 and that is at the top of safety.
Its taken a change of thyroxin to Synthroid over 2 years 8 months to regulate. I like Synthroid because it is a kiddie lock container., has a absorber in it and has an expiry date.
I found that liquorice interferes with result.One cant leave it creeping up as I would be become hyper or too low hypo.
Wife gets the invite every year around her birthday. One appointment for taking the blood and observations, the second follow up to discuss results with nurse. Its good that they are checking no adverse effects from the meds but then conversation always swings round to avoiding diabetes, healthier living, and statins. Our GP surgery is pretty insistent on keeping these appointments and starts being awkward on repeat prescriptions if we fail to have them.
Yes I’ve had one of these invitations as well- my GP surgery calls it a secondary prevention clinic. I’m already on high risk monitoring for amiodarone but I’m all for having more checks as this will cover other things as well. I didn’t get the impression that it’s anything to do with medication - just an MOT!
Thank you. Never had a medication review face to face although script always says review on such a such date. I believe when I request repeat online a doctor does it then at the said date? I have had 2 over the years with local pharmacist who is great. My GP has even referred me to him as he says they are far more knowledgeable about drugs.
Thanks. Mine were with pharmacist primarily as i had asked GP about one of my drugs/side effects and he recommended asking pharmacist. This was some years ago before I realised the true worth (I am ashamed to say) of a pharmacist’s knowledge of drugs was not just to fill scripts and checking it was correct dosage/patient etc. Next time I asked pharmacist myself.
I had an ansafone message inviting me in for blood tests,to ' see if my anticoagulation treatment needed adjusting'Im 63,so no age related reason. Im on Apixaban,so how can that be ' adjusted'
I had blood tests 6 months ago,all good.
So I have ignored it and have had no other communication from them!
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