The way things are done: I would like... - British Heart Fou...

British Heart Foundation

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The way things are done

Hometerry profile image

I would like to high lite how the procedure of after care should be done in my view.

You have your procdures, then a check out meeting from the hospitol say 4 weeks

later or so.They then release you from there care and after that you are in the the hands

of your gps, and need a referal before you can be seen at out patients clinic.

In my view surely they should give some mandatory check after a year or so.Evan a car gets an mot each year so why not people.I had stents done, so surely they would want to see if theres any changes to arterys etc.This would seem logical.Then if theres any problems they could deal with them.But in my experience they dont want to know the outcomes of there work.They just wait till you have a problem then act then.Its just my view but surely this would be the best way to reassure patients and check on there work and improve the service.Hopefully some may agree.Please say if you think I am wrong.

10 Replies

"so surely they would want to see if theres any changes to arterys"

This question goes to the core of UK cardiac medicine. The fact is relatively little meaningful cardiac predictive work is performed in the UK, either for people who have had heart problems or for the general population. Unlike cancer care, which is based on early diagnosis, cardiac care is based on intervening after a cardiac event has happened or is imminent. And this could be ten, twenty, or thirty years after heart disease first manifested itself in your body.

You'll get a crude assessment of your future cardiac prospects based on standardised risk factors. But these risk factors are far from watertight, witness the large number of young, slim, marathon runners that arrive on this forum completely baffled why they had a heart attack! There are plenty of risk factors that are completely ignored in the NHS (and indeed in the BUPA Wellman and Wellwoman) tests, with more being discovered all the time.

Then there are a group of assessment techniques that basically measure the flow of blood through the heart, for example ECG stress tests or angiograms. The problem is that measuring the flow of blood provides only a poor early warning for plaque build up. The proof of this is that a significant percentage of heart attacks occur in people whose arteries are less than 50% occluded, and as far as I know it's extremely difficult to measure accurately any flow difference in an artery that's less than 50% blocked.

However, there are a cluster of tests that do actually go the the root causes of heart disease. For example you can be tested with an ultra sound scan for a build up of calcium in the carotid arteries of your neck, or you can be X-Rayed for calcium build up in the arteries of your heart. But neither of these procedures are fully endorsed by NICE, so you'll find the occasional health trust that tinkers with them, but if you want to preemptively or regularly track your cardiac health with these techniques, and give yourself the benefit of a reliable early warning signal, then you'll probably have to pay for private medicine.

Hometerry profile image
Hometerry in reply to Chappychap

You seem knowledgeable about matters, but it was just a view.I was suggesting that a mandatory check up after a year or so would high lite any changes in placue or calcium build would reassure patients, and you could see any problem areas around the stents.As a layman it would seem a logical request, or is it better to wait as we do now

for patients to develop problems with the risks that follow.Thank you for comments.

jimmyq profile image
jimmyq in reply to Hometerry

I had the CT and MRI scans on my carotid arteries.

At our doctor's sugery, and I thought it was nationwide, we get an MOT every year after the age of 50. Mine is next week.

Chappychap profile image
Chappychap in reply to jimmyq

Jimmy there are two main ultra sound scans for the carotid arteries. One is a simple flow test, it uses the doppler principle to measure the flow of blood. The second is sometimes called the CIMT test, or Carotid Intima Media Thickness Test, which accurately measures the build up of calcium in the carotid arteries.

The first test I wouldn't get too excited about; but if you're having the second test, especially on an annual basis so you can monitor changes over time, then I'm very envious of your local health trust's policies!

Here in Hampshire the argument is that without explicit NICE approval they won't offer this test. A real shame as it would allow me to predict my risk factors much more accurately, and to quantifiably evaluate how my medication and lifestyle changes are working to manage my heart disease.

I've come to the conclusion that I either want a regular cardiac X-Ray to directly measure calcium build up in the heart, or the CIMT test to measure calcium build up in the carotid arteries. The first test has the advantage of direct heart measurement, but the second test has the advantage that it's ultra sound, so there's no radiation involved. However, getting either of these in my part of the world means paying to have it done privately.

jimmyq profile image
jimmyq in reply to Chappychap

I want tests to track my progress (or not) too but, like you, we can't get them round here. There is a private hospital that might do them but I can't afford that. You would think that they would want to monitor us hearties so that they could intervene if treatment was going awry.

i totally agree that once a discharge happens that things should then be put in place but sadly this is not happening.

i came out with complications and my supportive discharge has become totally sub standard leaving me housebound.

yes there are plans to be seen in clinics but what about in between a lot of people like me need that help and it is not there, it is only when things go seriously wrong that the excuses start to fly.

i have to say that the general surgeon was on the ball following my potassium situation and has instructed my doctors to keep checking but the other teams involved have not bothered to carry out vital tests which were instructed to do and nor have they then passed information on to the discharge team

sadly i have had to file to the patient liaison service as i have had enough of passing the buck but still stuck here with nothing, it will be worse as xmas is looming, all i can do is pray to god that i don't injure myself through negligence on part of the hospital.

it is also a sad case that people out there because of sub standards like no support are also filing cases.

I agree that the NHS operates (no pun intended!) largely on the basis of reacting to events, rather than prevention. After my hospital procedures and diagnosis/treatment plan I was discharged back to my GP's care. I have had to take the initiative to ask the GP about monitoring. He did respond OK to my suggestions for what might need checking, but if I hadn't pushed I doubt whether he would have taken the initiative. As for consultant support, I was told that if nothing changes no need to have consultant input. No doubt the NHS would respond magnificently if something did go wrong but it's a very passive approach.

No health care professional has ever mentioned weight or diet to me as ways of helping myself.

The new Health Secretary, Matt Hancock, has spoken recently about developing a more preventative approach, so let's hope there's a change in the wind but it will take a long time to turn the ship around.

In relation to what has already been said as above, I strongly feel that mainstream medicine is at the crossroad, be it Neurology or Cardiology both of which incidentally appear to be closely inter-related.

As someone else said, I totally agree that the current diagnostic tests are only effective in patients whose arteries are blocked at least 70 %+ and if your test results were "normal", you may go on to die from the heart attack but nothing is done about these "lower than 70% patients", who generally lead a healthy lifestyle i.e. non-smoking, eating healthy, not obese etc whilst there are other hidden risks in these patients. These patients (who were told the test was negative) did not know their arteries were still "diseased" despite the neg. test results, simply because these diagnostic tests were not sensitive enough to reveal the pre-70% change. You weren't sick enough, your arteries weren't blocked enough, your heart attack was not imminent enough, you are still standing and breathing. So you are sent home.

You get sent away. You go on to live with your symptoms. There is a bias in cardiology. A site like this helps raise awareness of this fact.

I'm checked every 6 months by Surgeon or senior Cardiologist, imaging Cardiac consultant.

Cardiac Rehab are still testing me weekly and monthly.

I'm also under 4 Hospitals for my condition which is stable all vitals are fine.

I must be lucky 🍀 I'm being well looked after by NHS cant fault them thus far. Everything is checked every 6 months

at least.

Well big T where the hell do you live,or are you paying private.x

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