I have seen quite a few people here and on other forums asking similar questions. Why have they not offered me an ablation? OR Why are they offering me an AV Node Ablation and a pacemaker?
This really got me wondering about why???? I have spoken to a few others about it including some in the medical profession in the UK and others who lecture on AF around the world. I am going to copy/paste an answer I got from Mellanie True Hills who is the CEO of Stopafib.org and travels the world speaking on AF education and treatment. She pretty much sums up what I have gotten from others that I asked.
"In the UK, with the National Health Service (NHS), a lot depends on the location of the patient. I'm no expert, but I know that there are individual "trusts" throughout the country that administer healthcare, and treatment can vary from trust to trust.
In some (many) trusts, there is a tight focus on cost control. Doctors can be under great pressure to keep costs down. That may mean that patients have a difficult time getting referred to specialists, and often are treated by consultants (primary care).
They also may not be offered expensive procedures, such as catheter ablation or surgical ablation (maze/mini maze). Catheter ablations are actually far more common than surgery for afib; in fact, afib surgery is very rare.
Catheter ablations may require multiple procedures, making them costly, so they are less likely to be offered to patients over a certain age. AV node ablation (many of you know how I feel about that) is a one-time procedure, so it ends up being more cost effective for the trust, and therefore is commonly prescribed because there is some finality to what it costs the system."
Mellanie
I used the example of cutting off the arm to get rid of a hangnail and they agreed and stated that if you cut the arm off then you'll never have to pay for a hangnail again.
Although I do not like the answer I was given.... Now I can understand the questions.
Tim
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Thanks Stand - that is helpful, generally accurate and sums up the government national health care situation in the UK. The differences in care from area to area are cited as "the post code (zip code) lottery". In our system "consultants" are the specialists, primary care means the general practitioner/family doctor.
Hi Tim, Whilst this may well be the truth there is also an element where patient knowledge and determination can play a part. It is the right of patients to be treated wherever and by whoever they wish but sometimes it is hard for them to get past their GP (family doctor) due to the cost situation. In UK a catheter ablation costs around £12-14,000 so there is a substantial outlay for the local health care trust. I find it unacceptable that people are not offered ablations more readily BUT there is a European Society of Cardiology protocol , written in 2009, which suggests that patients must have failed to respond to drug therapy first. These are also the NICE Guidelines.* .Sadly many doctors are still in the dark ages where AF is concerned and that includes a fair number of cardiologists. One only has to look at the number of AF patients prescribed aspirin , which has been shown to be ineffective for stroke prevention in AF , to recognise that.
One must also understand that AF treatment is very new science. Twenty years ago AF was considered a benign nuisance and patients expected to live with it. The first European catheter ablations were around 1994 and since then much progress has been made and results improving but there is still some doubt about the long term effectiveness of the procedure. I understand there is a 50% likely hood of AF recurrence post five years.
In conclusion, yes there is a post code lottery but that applies in any health treatment in UK, but patient education and determination can override this..
Personally, having had three ablations, three cardioversions, a radical prostatectomy followed by radiation treatment etc. for prostate cancer and a hernia repair following the above all under NHS care I have no problems with our health service. (I understand that the hormone implants I am currently on for probably a total of three years are "astronomically expensive" according to my practise nurse and make my ablation treatment look cheap.)
* NICE is the National Institute for Clinical Excellence or as more commonly known National Institute for Cost Effectiveness. They decide what procedures , treatments and drugs may be used by NHS services in UK.
"In the UK we refer to our primary care doctors as "GPs". They are the first
stop. They can then refer you on to consultants. The consultants specialise in
EP, cardio etc.
The GP's are referred to as Dr... However the consultants are usually referred
to as Mr..... This relates back to the time of barber surgeons, thus Consultant
Surgeons use "Mr" to differentiate themselves from doctors, as barbers would not
have had a medical qualification. (They do now in case anyone thinks the NHS is
that backward!).
In the NHS it can take a few months to get an appointment with a consultant. I
pay for extra health cover through an organisation called "BUPA" which means I
can get in to see a consultant of my choice in about 2 weeks. That costs about
UKP2,000 p.a. (or USD3,000) for my family.
I went through the usual rigmarole of beta blockers, calcium channel blockers,
flecainide etc. none of which worked. I eventually went to see Prof Schilling in
London, a consultant EP and one of the best in the country, about 3 years ago.
We agreed I needed an ablation. I had this done privately but he could have done
this through the NHS. It was fortunately successful first time.
It is possible to get PVI ablations through the NHS, though you will probably
not be offered one automatically. If you ask you will usually get one and you
can have your choice of EPs as well. So it is a question of being as
knowledgeable as possible and knowing the system.
There are still a few old fashioned cardios who believe in pace and ablate (AV
node ablations) but that is becoming rarer.
There isn't an age cut-off for PVI ablations but it would probably be difficult
to get one if you're over 75-80.
In the UK we always like it the way we've always done it, and the US, as an
ex-colony, probably feel they need to be different!"
I would add that I am not aware of a particular post code lottery on ablations in the UK. Under "Choose and book" available at all GPs, it is possible to request referrals to EPs in other areas. Others might correct me however.
What I would say is that I don't think the NHS is any worse than the US system overall. In the US I've met people who can't get treatment because they can't afford it!
As to the statement that US doctors prescribe treatment because "..as an ex-colony, probably feel they need to be different" --- of course it's not because the US is en ex-colony (We are? How and when did that happen?).
If US doctors choose to be different it's because they observe the poor outcomes in the British health system when compared to those in the US.
But I think that US doctors, like the US soldiers who whipped the Brits a couple of hundred years ago, have superior skills to their British counterparts.
Of course, even with those superior skills, which are a result of dozens of years of advanced training, knowledge of medical fact and research, and years of experience; when they need to make a medical decision, they disregard all of that and base their decisions on: "What would a British doctor do here because I need to do something different."
Hello Tim, I am particularly interested in Av Node Ablation as it has been suggested to me as apossibility . Do you know what exactly Mellanie True Hills opinion on AV Node ablations is please!? I don't like the sound of it at all .
She does not agree with the procedure unless all else has failed. Most here feel that it is a last choice treatment. Also I do have a close friend who had the procedure done many years ago, has a pacemaker and still has AF. From my questions to other who have had it, They explained that even though the pulse telling the heart to beat is now coming from a pacemaker... The heart can still develop other pathways which allow that pulse to "echo" and cause forms of AF.
My major problem with it is making a patient totally dependent upon a pacemaker to possibly cure a rhythm problem when there are so many other methods available.
Thank you Tim, I do appreciate your comments. Do you know anyone who has undergone minimally invasive surgery -- cox maze procedure I think it's called here.
I had the Maze procedure in 2006. When I was first diagnosed as having AF, I was also told I was born with a hole in the heart.It was suggested at that time that it would be keyhole surgery, after closer investigation they found the hole was too close to the valves, so they went in through the chest, they also performed the Maze procedure.
The surgery was done in Guys hospital, Dr Rousin, cardiologist at St Margarets hospital, Epping referred me.
Cryosurgery is also used in cancer treatments. I have been teaching people with cancer for many years, I have a few with me now. One young lady had A brain tumour, very brave and gentle young lady.
I had an AVnode ablation 3 years ago and it was the best thing I have ever done. Yes I am occasionally aware of the AF, this ablation does not stop AF it just stops the symptoms so life can carry on as normal. It really is no big deal being pacemaker dependant.
The AV node is ablated so although the atria are still fibrillating this message does not get through to the ventricles and this beat is controlled by the pacemaker. If nothing else has worked I would say go for it.
I think that age is a factor here as the batteries only last approx 10 years so the younger you are the more pacemakers you have to have, so it is not that cheap an option.
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